Problematic Behavior: What do CACREP Acredited Program Policies and Procedures Reflect by Maranda Brown A disertation submited to the Graduate Faculty of Auburn University in partial fulfilment of the requirements for the Degre of Doctor of Philosophy Auburn, Alabama August 6, 2011 Keywords: problematic behaviors, gatekeeping, remediation Copyright 2011 by Maranda Brown Approved by Jamie Carney, Chair, Profesor of Special Education, Rehabilitation, and Counseling Chippewa Thomas, Asociate Profesor of Special Education, Rehabilitation, and Counseling John Dagley, Asociate Profesor of Special Education, Rehabilitation, and Counseling i Abstract Counselor Education programs are ethicaly obligated by acreditation standards and profesional codes of ethics to identify counselors-in-training whose academic, clinical, and personal performance indicate problematic behavior that would potentialy prevent them from entering the profesion (McAdams, Foster, & Ward, 2007). Despite these obligations, criteria by which to addres problematic behavior are not readily available, and programs are resigned to independently interpret and develop policies and procedures to addres these isues. This present study identifies and analyzes the policies that addres how Council for Acreditation of Counseling and Related Educational Programs (CACREP) doctoral Counselor Education programs define, ases, and remediate problematic behavior. To fulfil this purpose, a review of the literature and policy analysis was undertaken. Once the data was gathered, qualitative analysis was utilized to answer the questions about the components of the policies. Coding procedures identified emergent themes. The study intends to provide implications for counselor education programs, counselor educators, and prospective CACREP programs. ii Acknowledgments I would like to expres my most sincere gratitude to my advisor, Dr. Jamie Carney, for her guidance and support in the acomplishment of this research and my succes in this program. In addition, I appreciate the wilingnes of Drs. Chippewa Thomas and John Dagley to be part of my commite. Without your fedback during this proces, I could not have been a succes. Furthermore, support given by Drs. Daniel Henry and Paris Strom is acknowledged with sincere appreciation. I am blesed to have been raised by wonder parents who instiled in me a strong work ethic, resiliency, and to value education. Thanks to my parents for your prayers, love, and support. This endeavor would not have been possible without a strong support system of friends who encouraged, supported, and listened to me throughout the journey. Most importantly, I am grateful to friends who provided childcare, nurture, and love to my son Kenneth who, when I began the program, was a toddler. My presing toward the mark in this program was mainly to create a beter life and opportunities for my son Kenneth. I thank him for being motivation to me and alowing his mom to pursue this goal. Nelson Mandela in a 1994 Presidential Inauguration said, ?Our deepest fear is not that we are inadequate. Our deepest fear is that we are powerful beyond measure. It is our light, not our darknes that frightens us?We are born to manifest the glory of God that is within us.? This work is dedicated to every individual who?s ever ben told that they can?t, that they wouldn?t, iv and began to believe it. I charge you to defy the odds because you are so much more than you can se and you are so much more than what you?ve heard! v Table of Contents Abstract..................................................................i Acknowledgments .........................................................ii List of Tables............................................................vii Chapter I. Introduction.......................................................1 Statement of the Problem...............................................6 Purpose and Significance................................................7 Research Questions....................................................9 Definition of Terms....................................................9 Summary...........................................................10 Chapter I. Literature Review.................................................12 Introduction.........................................................12 Problematic Behavior.................................................13 Types of Problematic Behavior....................................16 Profesional Standards and Cals.........................................20 APA........................................................20 ACA........................................................22 Profesional Cals....................................................25 Counselor Education Programs? Response to Problematic Behavior..............28 Pre-Admision.......................................................34 vi Post-Admision......................................................36 Remediation, Intervention and Dismisal...................................39 Summary...........................................................42 Chapter II. Methodology....................................................43 Sample............................................................43 Measures...........................................................44 Procedures..........................................................45 Data Analysis.......................................................49 Summary...........................................................49 Chapter IV. Results.........................................................51 Demographics.......................................................52 Results............................................................52 Themes Across Definitions of Problematic Behavior....................53 Common Themes in How Problematic Behavior is Asesed..............58 How Problematic Behavior is Asesed........................58 When Problematic Behavior is Asesed.......................64 Who Aseses Problematic Behavior..........................66 Common Themes in the Proces and Procedures Identified for Remediation of Problematic Behavior.......................67 Summary...........................................................71 Chapter V. Discussion.......................................................72 Introduction.........................................................72 Discussion of the Findings..............................................73 Research Question 1............................................73 vii Research Question 2............................................75 Research Question3.............................................77 Limitations.........................................................79 Recommendations for Future Research....................................80 Implications........................................................81 Summary...........................................................82 References...............................................................84 Appendix A: List of Policies Reviewed.........................................94 Appendix B: Tools Used To Ases Problematic Behavior..........................96 vii List of Tables Table 1 Common Factors Asociated with Student Unsuitability in Social Science Programs.16 Table 2 Words Used to Define Problematic Behavior...............................52 Table 3 Tools used to Ases Problematic Behavior................................59 Table 4 Common Asesment Areas Used in Tools to Ases Problematic Behavior........61 Table 5 Frequency Problematic Behavior is Asesed...............................64 1 CHAPTER I. INTRODUCTION Counselor educators are skiled teachers and practitioners who are profesionaly trained to prepare counselors through academic instruction, supervision, and clinical practice. Individuals within the field may work in a variety of setings including, primary schools, universities, mental health centers, governmental agencies, and private practice. Within these setings, unique opportunities and chalenges exist, requiring varying levels of responsibility. In the role of a counselor, the American Counseling Asociation (ACA) has denoted the primary responsibility of promoting the welfare of the client (ACA, 2005). As a counseling supervisor, one is further required to provide performance appraisal and evaluative fedback (ACA, 2005). From the instructor role, one is expected to be a profesional role model who adheres to ethical, legal, and regulatory aspects of the profesion (ACA, 2005). Ultimately, the counselor educator is required to monitor counselors-in-training in regard to profesional fitnes to serve as a counselor. This role, the evaluation of counselors-in-training, is often deemed as one of the most critical responsibilities of counselor educators (Brear, Dorrian, & Luscri, 2008; Carney & Cobia, 1996; Frame & Stevens-Smith, 1995; Kerl, Garcia, McCullough, & Maxwel, 2002; Li, Trusty, Lampe, & Lin, 2008; Lumadue & Dufey, 1999; McAdams, Foster, & Ward, 2007; Olkin & Gaughen, 1991). The task of evaluating counselors-in-training requires the identification of ideal and problematic behaviors. Problematic behavior has been refered to by many terms; profesional performance deficiencies (McAdams & Foster 2007), incompetence (Forrest, Elman, Gizara, & 2 Vacha-Hase, 1999), problematic students/ trainees (Cobb, 1994 as cited in Wilkerson, 2006; Rosenberg, Arcinue, Getzelman, & Oren, 2005), profesionaly deficient trainees (Gaubatz & Vera, 2006), and most notably, impairment (Forest et al., 1999; Lamb, Preser, Pfost, Baum, Jackson, & Jarvis, 1987). Impairment exists within many disciplines and was formerly recognized first within the medical field when the American Medical Asociation (AMA) made an efort to asist impaired physicians (Shefield, 1998). An impaired physician as defined by the AMA is one that is unable to practice medicine with reasonable skil and safety due to physical or mental disabilities to include deterioration due to aging or loss of motor skil, or abuse of alcohol and drugs (Robertson, 1980, as cited in Stadler, Wiling, Eberhage & Ward, 1988). In his work with substance abusing physicians, Bisel (1983), made a distinction betwen incompetent physicians, unethical physicians, and impaired physicians with the later being those who were poorly trained or failed to stay current in the field. After the medical field defined impaired and the behaviors that characterize impairment, the concept was broadened within other disciplines. By 1981 the American Psychological Asociation began exploration of problematic behavior by including an open forum on its conference agenda, which identified some of the most frequent problems (physical and emotional handicaps, alcohol and drug dependence, sexual relationships with students and/or clients, mental ilnes and suicide) contributing to impairment (Stadler et al., 1988). Rosenberg et al. (2005) defined impairment for psychology trainees as having a serious deficit in the areas of personal functioning, knowledge and application of profesional standards, and competency in areas such as conceptualization, diagnosis, asesment, and appropriate clinical interventions. 3 It was not until the publication of an article on counselor impairment in the February 1988 isue of the Journal of Counseling & Development that problematic behavior gained significant atention within the counseling profesion (ACA, 2009). Forest et al. (1999) defined impairment as diminished profesional functioning atributable to personal distres, burnout, and/or substance abuse and unethical and incompetent profesional behavior. Causes for such distres can be due to chemical dependency, mental ilnes, and personal conflict and often interfere in profesional functioning (Laliotis & Grayson, 1985). Emerson and Markos (1996) saw additional distres factors, depresion and sexual exploitation, as a halmark of their impairment definition. Lawson and Venart (2005) note that therapeutic impairment, as defined by an ACA Taskforce on Impaired Counselors, ?ocurs when there is a significant negative impact on a counselor?s profesional functioning which compromises client care or poses the potential for harm to the client.? In providing the ethical framework that addreses impairment ACA (2005) refers to physical, mental, or emotional problems that could result in harming the client or others. A variety of terms and definitions, across multiple disciplines, exist that embody similar characteristics and behaviors. It has been aserted that a distinction should be made betwen impairment and problematic behavior because of the relationship betwen some forms of problematic behavior (e.g., psychological disorders) and the recognition in the ADA (Americans with Disability Act) about the protection of rights of persons with these types of disabilities (Frame & Stevens-Smith, 1995; Vacha-Hase, Davenport & Kerewsky, 2004). Additionaly, Rosenberg et al. (2005) note that impairment ?suggests diminished functioning from an adequate level of competence.? Moreover, the term incompetent has negative connotations that suggest an individual hasn?t achieved a desired level of competence and place universities at risk for litigation (Rosenberg 4 et al., 2005). The choice of terminology is mared, containing risks and implications asociated with each. Therefore, for the purposes of this research the term problematic behavior has been adopted to guide the remedial practices within CACREP Counselor Education programs. A shift to a similar descriptor has been advocated for by Rosenberg et al. (2005). The term impairment is utilized to maintain the fidelity of previous literature citations. Problematic behavior can occur at any point within graduate training and may even be evident at the time of program application. To addres this isue many programs have developed admision criteria or methods to ases for indicators of problematic behavior. However, it is very chalenging to develop such asesment with demonstrated succes. For example, Eriksen and McAulife (2006) postulate that a review of undergraduate grades and standardized test scores are inefective in predicting efective acquisition of counseling skils. For this reason, many colleges and universities utilize an interview proces that involves screning, aimed at identifying individuals that may not be best suited for pursuit of a degre in counselor education. Such interviews alow faculty to ases personal characteristics, which have been cited as a contributing factor to succesful counseling outcomes (Wampold, 2001). Students recommend enhanced admisions procedures and screning to addres this isue (Rosenberg et al., 2005). Gatekeeping is a means to addres these concerns. Gatekeeping aims to ensure the health of the profesion by controlling aces to it through evaluation of student suitability for the profesion (Brear et al., 2008). Colleges and universities implement identified evaluative criteria and proceses that help guide evaluative decisions necesary for admisions and matriculation. Despite the most efective gatekeeping strategies a college and university might employ, there is always an occasion for gateslipping to occur. Gateslipping occurs when deficient trainees continue to advance through training programs without remediation, dismisal, or follow-up 5 (Gaubautz & Vera, 2006). This is just another area of support for asesing and addresing the isue of problematic behavior in programs, and thus the reason why we se and must addres problematic behavior within counselor education programs. Gaubatz and Vera (2006) reported that impaired counselors in training constituted betwen 4% and 5% of students requiring remediation with as many as 10% of students in programs needing but not receiving remediation. Research has indicated that problematic behavior often encompases inadequate social skils, deficient interpersonal skils, supervision dificulties, unprofesional demeanor, and academic dishonesty (Vacha-Hase, 1996). Supporting this are the findings that as much as 89% of student impairment was the result of insufficient clinical skils and/or personality or emotional problems (Procidano, Busch- Rossnagel, Reznikoff & Geisinger, 1995). Since problematic behavior often corresponds to social, psychological and emotional problems it is not surprising that peers in programs are often the first to identify this type of behavior. An investigation by Mearns and Alen (1991) indicated that 95% of students were aware of impairment among their peers which suggests the vital role that students can posses in gatekeeping. The disparity previously noted by Gaubatz and Vera (2006) betwen the percentage of students that are impaired and remediated (4?5%) and those that are impaired and unremediated (10%) suggests that a greater level of identification exists among peers that go unreported to faculty. Gaubatz and Vera?s (2006) findings underscore this notion, in that students are more keenly aware of deficiencies among their peers than faculty are. A 2004 random survey of ACA members revealed that 63.5% of counselors have known someone that they would identify as impaired and 75.7% agred that impairment presents a significant risk to the profesion (ACA, 2009). 6 One of the reasons peers may be identifying this behavior is that individuals experiencing these concerns are often hesitant to sek help or unaware of the impact of their behavior. This raises additional concerns, for masking problematic behavior in and of itself can contribute to increasing the severity or impact of the impairment. Hard (2007) noted that monitoring one?s own impairment is a dificult task when one is experiencing the efects of impairment. In addition there are varying levels of self-awarenes, insight, and wilingnes to acknowledge personal limitations (Schwartz-Mete, 2009). For this reason Schwartz-Mete (2009) suspects that self-acknowledgment and/or self-monitoring are not sufficient to remediate the problem of identifying impairment. Olsheski and Lech (1996) speculate reluctance to self-report and peer- reporting may be due in part to undefined and uncertain procedures and consequences. Compounding this reluctance is the fact that few published, formal asesment tools exist for conducting evaluation of students? personal and profesional development (Hensley, Smith & Thompson, 2003). With a scarcity of asesment tools peers are relied upon as a means to evaluate impairment. Statement of the Problem Counseling literature is replete with writings that underscore the importance of asesing and evaluating problematic behavior of counselors-in-training. Olkin and Gaughen (1991) note that faculty are charged in their responsibilities to evaluate students for academic and clinical proficiency. Carney and Cobia (1996) asert that evaluation of problematic behavior should be integrated into overal asesment in counseling programs. Brear et al. (2008) regard screning and asesment as an important and esential component of counselor educators? responsibilities. This is reinforced in the ACA Code of Ethics (1995) which clarifies that these are required and necesary responsibilities for counselor educators (se Standard F.9. Evaluation and 7 Remediation of Students). Similarly, CACREP standards (2009, Section I.L, & I.P) emphasize the role of asesing and remediating problematic behavior as an integral part of counselor training. Moreover, these profesional standards specify that this proces should be integrated into admisions decisions and al aspects of students? progresion through their programs. In addition, Standard F.9.a of the ACA Code of Ethics (2005) clarifies that students need to be informed, prior to admision and while in the program, about the specific proceses and practices that a program uses to met this profesional standard. This mets a standard of informed consent, alowing students to make an informed decision about a program, and their enrollment prior to their acepting admision. While these standards have been established there are stil concerns and questions about the methods and means that counselor education programs use to implement such standards. In addition, there are concerns about what constitutes problematic behavior (Ericksen & McAulife, 2006; Rosenberg et al., 2005). These isues al combine to create a central isue; programs are mandated to ases problematic behavior as part of admisions and program atriculation. However, there is a paucity of research that addreses how programs met this requirement; of special interest is how programs met the requirement to provide informed consent. This includes consideration of how problematic behavior is defined, what are the characteristics and content of policies and procedures and how they are distributed to students (Elman & Forest, 2007; Henderson, 2010; Ziomek-Daigle & Christensen, 2010) Purpose and Significance Acreditation standards and ethical standards require colleges and universities to identify and addres factors that could impede counselors-in-training ability to become efective counselors. Several articles have been published exploring problematic behavior. The majority 8 of these articles focused on the profesion of counseling and rarely examined the concept of the remedial practices employed by universities to addres the problematic behavior. These articles provide a framework that clearly benefits the field and underscores the impact of problematic behavior on the profesion. However, to date, information on the specific remedial practices aimed at addresing problematic behavior is limited. Hensley et al. (2003) indicated that counselor educators need guidance to develop comprehensive writen policies to addres problematic behavior that are made available to those students. Moreover, Frame and Stevens-Smith (1995) underscore the necesity of having clearly defined policies and procedures that are implemented. Additionaly, Baldo and Softas-Nal (1997) ofer considerations for inclusion in these prospective policies. The purpose of this study was to examine how acredited counseling programs define, ases, and remediate problematic behavior of counselors-in- training. The outcome data obtained in this study identifies the common themes in how problematic behavior is defined, the methods used to ases problematic behavior, and the proceses used to remediate problematic behavior. Moreover, providing definitive criteria on asesment, evaluation, and remediation can guide fair and legaly defensible decision making about problematic behavior. Ultimately the outcome data from this study could improve the screning of problematic behaviors and provide useful information to inform formalized policies that addres problematic behavior. This study atends to gaps in literature on the remediation proceses and the policies and procedures that addres problematic behavior in counselor education programs. This study has the potential to contribute to prior research that has emphasized the importance of having wel-developed policies and procedures in counselor education. Information gained from this study provides additional information that could 9 potentialy contribute to the enhancement of existing policies and procedures and the establishment of new policies and procedures for colleges and universities who desire to be CACREP recognized. Finaly, it is believed this study highlights the need for ensuring these policies and procedures are acesible and routinely communicated to counselors-in-training. Research Questions Research questions for this study were as follows: 1. What are the common themes across definitions of problematic behavior in CACREP acredited doctoral Counselor Education programs? 2. What are the common themes in how problematic behavior is asesed in CACREP acredited doctoral Counselor Education programs? 3. What are the common themes in the proceses and procedures identified for remediation of problematic behavior in CACREP acredited doctoral Counselor Education programs? Definition of Terms CACREP: Council for Acreditation of Counseling and Related Educational Programs. As an acrediting body, CACREP provides leadership to promote excelence in the profesional preparation of counseling and related educational programs (CACREP, 2010). Counselor Education: An academic discipline that focuses on promoting the training of competent profesional counselors (Hil, 2004). Gatekeping: Gatekeeping is the evaluation of student suitability for profesional practice. It is a mechanism that aims to ensure the health of the profesion by controlling aces to it. It involves the identification of evaluative criteria and proces, and the acountability of the 10 gatekeeper to apply the criteria and take responsibility for the evaluative decisions (Brear et al., 2008). Gateslipping: The rate at which potentialy deficient trainees in a given program ay advance through their training without remediation, dismisal, or follow-up (Gaubautz & Vera, 2006). Impairment: Trainee impairment is an interference in profesional functioning that is reflected in one or more of the following ways: (a) an inability and/or unwilingnes to acquire and integrate profesional standards into one?s repertoire of profesional behavior; (b) an inability to acquire profesional skils to reach an aceptable level of competency; (c) an inability to control personal stres, psychological dysfunction and/or excesive emotional reactions that interfere with profesional functioning (Lamb et al., 1987). Problematic Behavior: Those behaviors, atitudes, or characteristics that need to be the focus of atention and change but are not considered excesive or inappropriate; they may in fact be important components of one?s learning experience (Wilkerson, 2006). Remediation: Instruction during the progres of a course (or study of a body of material) in acquisition of basic prerequisite skils that are esential for eventual succes in the course. In the current educational literature, the term remedial instruction is almost always paired with developmental instruction (i.e., ?remedial/developmental?), suggesting an inseparable relationship betwen the aleviation of deficiencies and the development of new competencies (McAdams & Foster, 2007). Sumary In closing, this chapter provided an overview of the ethical responsibility that counselor educators have to define, ases, and remediate problematic behavior. Of particular concern to 11 this current study is the absence of research on how CACREP acredited doctoral counselor education programs addres these responsibilities. Counselor educator roles, ethical requirements, and defining the isue of problematic behavior were reviewed. Additionaly, the chapter addresed the focus of this study. The literature review for this study is discussed in the following chapter. 12 CHAPTER I. REVIEW OF THE LITERATURE Introduction Counselor education programs are responsible for producing graduates that are ready to asume al the responsibilities of profesional practice. Thus, programs must make decisions regarding their knowledge, skil, and personal disposition for the profesion (Brear et al., 2008; Wilkerson, 2006). More often than not this proces is not met with dificulty; however, there are occasions where faculty must question a student?s suitability for the profesion. Completion of a training program is typicaly the measure by which profesional asociations acredit readines to practice (Brear et al., 2008). Moreover, ethical and acreditation standards provide a framework for the continual evaluation, appraisal and the need for policies to remediate students when appropriate. The ACA denotes this responsibility in F.5.a. of the Code, ?provide supervises with ongoing performance appraisal and evaluation fedback,? and F.5.b. further indicates that ?supervisors asist supervises in securing remedial asistance when needed? (ACA, 2005). Consistent with the ACA Code of Ethics, the CACREP standards state that ?program faculty conducts a systematic developmental asesment of each student?s progres throughout the program (Standard P). There is, however, a paucity of research on the actual practices counselor education programs employ to ases, addres, and remediate problematic behavior. 13 Problematic Behavior An aray of terminology has been used to describe problematic behavior. Descriptive words such as deficient (Gaubatz & Vera, 2002; Procidano et al., 1995), problem (Gaubatz & Vera, 2006; Olkin & Gaughen, 1991), profesional performance deficiencies (McAdams & Foster, 2007), incompetent (Brear et al., 2008; Forest et al., 1999), bad (Wheeler, 2000), problematic students/trainees (Rosenberg et al., 2005; Cobb, 1994, as cited in Wilkerson, 2006), profesionaly deficient trainees (Gaubatz & Vera, 2006), troublesome (Russel & Peterson, 2003), unsuitable (Brear et al., 2008) and impairment (Boxley, Drew & Rangel, 1986; Forrest et al., 1999; Huprich & Rudd, 2004; Lamb et al., 1987). When such an aray of terminology exists, confusion is evident. Terminology has been interchanged and definitions overlapped (Vacha- Hase et al., 2004). Definitions have been appended (Lamb, Cochran, & Jackson, 1991) and variations in application of terminologies have been drawn (Or, 1997). The term impaired was used in other profesions, social work and medicine, when describing problematic profesionals (Forrest et al., 1999). Similarly, early in the 1980s, the term was adopted by mental health profesionals early on to describe a range of situations involving profesional performance deficiencies with students (Forrest, et al., 1999; Frame & Stevens-Smith, 1995; Huprich & Rudd, 2004; Lamb et al, 198, 1991; Wilkerson, 2006). Lamb et al. (1987) defined impairment within a training context as: an interference in profesional functioning that is reflected in one or more of the following ways: (a) an inability and/or unwilingnes to acquire and integrate profesional standards into one?s repertoire of profesional behavior; (b) an inability to acquire profesional skils to reach an aceptable level of competency; (c) an inability to 14 control personal stres, psychological dysfunction and/or excesive emotional reactions that interfere with profesional functioning. (p. 598) This definition has been cited and referenced in several articles (Forest et al., 1999; Henderson, 2010; Oliver et al., 2004) and used as the basis to expand definitions. However, the terms impaired and impairment are mared with criticism (Bhat, 2005; Bemak et al., 1999). It has been aserted that a noted distinction should be made betwen impairment and problematic behavior because of the relationship betwen some forms of problematic behavior (e.g., psychological disorders) and the recognition in the ADA (Americans with Disability Act) about the protection of rights of persons with these types of disabilities (Frame & Stevens-Smith, 1995; Vacha-Hase, Davenport & Kerewsky, 2004). Disability as defined by the ADA is: ?(A) a physical or mental impairment that substantialy limits one or more of the major life activities of such individual; (B) a record of such an impairment; or (C) being regarded as having such an impairment? (ADA, 1990, sec. 3[2]). Use of the term impairment therefore has implications that counselor educators must be aware of and care taken when evaluating students for retention in counselor education programs (Frame & Stevens-Smith, 1995). Additionaly, Rosenberg et al. (2005) note that impairment ?suggests diminished functioning from an adequate level of competence.? Moreover, the term incompetent has negative connotations that suggest an individual hasn?t achieved a desired level of competence and place universities at risk for litigation (Rosenberg et al., 2005). Elman and Forest (2007) caled for discontinuation of use of the term impaired. Alternatives to the use of the terms impaired or impairment have been suggested. Most recently, a plethora of terminology has been offered, terms that deal with character and fitnes. Johnson and Campbel (2002, 2004, as cited in Elman & Forest, 2007) define character as 15 integrity, prudence, caring, and sensitivity to the welfare of others and fitnes to practice as emotional stability, which includes personal adjustment, psychological health, and absence of substance. Elman and Forrest (2007) have offered problems with profesional competence as an alternative to describe problematic behavior. Forrest, Miler, and Elman (2008) later expanded this alternative descriptor to trainees identified with problems of profesional competence. Terminology has continued to evolve, shifting from emphasis that would suggest program dismisal toward potential for remediation. Noted inconsistencies in terminology and definitions make it dificult to ases, addres, and remediate problematic behavior (Bhat, 2005). For the purposes of this research the term problematic behavior has been adopted to explore the remedial practices within the Council for Acreditation of Counseling and Related Educational Programs (CACREP) counselor education programs. The term impairment wil be utilized to maintain the fidelity of previous literature citations. The new descriptor, problematic, has been recommended and is beginning to be adopted, though the term has not been fully operationalized (Brear et al., 2008; Oliver, et al., 2004; Rosenberg et al., 2005; Vacha-Hase et al., 2004). Problematic behavior, as defined by Wilkerson (2006) are those behaviors, atitudes, or characteristics that need to be the focus of atention and change but are not considered excesive or inappropriate; they may, in fact, be important components of one?s learning experience. Kres and Protivnak (2009) note these behaviors are exhibited in academic or dispositional deficiencies. Problematic behavior may result in an interference in profesional functioning that is manifested in many ways. Interference in profesional functioning may be the result of personal distres, burnout, and/or substance abuse that could result in unethical and incompetent profesional behavior (Forrest et al., 1999). Left unaddresed, these physical, mental, or emotional problems could have significant negative impact on client care (Lawson & 16 Venart, 2005) and place counselor education programs at risk for legal litigation (Schoener, 1999). Therefore it is necesary for faculty to be able to ?recognize when students? personal isues or behaviors prohibit them from folowing profesionaly acepted standards of practice? (Kerl et al., 2002). Types of Problematic Behavior Many factors can contribute to impairment and at any given time al counselors operate on a pendulum from ?wel? to ?impaired,? as noted by the ACA (2009). Forest et al. (1999) found clinical deficiencies, interpersonal problems, problems in supervision, and personality disorders as the most common factors found in impairment. Brear et al. (2008) expanded these factors as ilustrated in Table 1, which synthesizes 14 empiricaly based studies citing the most frequently cited factors involving student impairment. Table 1 Common Factors Asociated with Student Unsuitability in Social Science Programs Date published Authors Five Most Frequently Cited Factors (first listed being the highest ranked) 1983 Biaggio, Gasparikova- Krasnec, and Bauer Most frequently ranked conditions considered sufficient to warant dismising a doctoral clinical student presuming warning has been given: Violation of profesional ethics Psychopathology Substandard academic performance Therapy skils not mastered Judgment poor (table continues) 17 Table 1 (continued) Date published Authors Five Most Frequently Cited Factors (first listed being the highest ranked) 1986 Boxley et al. Most frequently cited factors asociate with intern?s impairment: Personality disorder Depresion Emotional problems Marital problems Physical ilnes 1991 Olkin and Gaughen Most frequently cited problems for which students are identified: Academic deficits Problems in clinical skils Pervasive interpersonal problems Problems in supervision Intrapersonal problems 1995 Koerin and Miler Most frequently listed types of non-academic situations or behaviors that warant terminating a student from a masters social work program: Ethics isues Mental health isues Substance abuse Field performance problems Clasroom behavior problems 1995 Procidano et al. Most frequently cited problems of a non-academic nature which show evidence of being unsuitable for clinical work: Limited clinical skils Personality/emotional problem Unethical behavior 1997 Ryan, Habibis, and Craft Most likely non-academic reasons our program actively pursues counseling out a student: Obvious emotional/mental problems Inability to respect human diversity Non-conformity to social work values Personal values inconsistent with social work 2003 Russel and Peterson Most frequently ranked concerns from list of indicators of student impairment: Ethical violations Unprofesional conduct Suicide atempts Substance use/abuse Possible signs of a personality disorder 18 Table 1 (continued) Date published Authors Five Most Frequently Cited Factors (first listed being the highest ranked) 2004 Huprich and Rudd Most commonly reported impairments based on knowledge of program over past 10 years: Personality disorder Depresive symptoms Adjustment disorder Anxiety symptoms Alcohol 2004 Lafrance, Gray and Herbert Most frequently cited potential indicators that suggest a person may not be suitable for the practice of social work: Personal qualities: maturity, integrity Capacity to develop profesional social work relationships with clients, colleagues, staf, and community members Congruence betwen what individuals bring to the profesion and the values, principles, and beliefs of the social work profesion 2004 Oliver et al. Most frequently cited types of problems/impairments observed in student colleagues: Depresion and other mood disorders Personality disorders or traits Anxiety disorders Eating disorders Substance abuse 2004 Vacha-Hase et al. Most frequently cited types of student dificulties actualy encountered during the past year that did not lead to termination: Inadequate clinical skils Defensivenes in supervision Deficient interpersonal skils Emotional problems Physical ilnes 2005 Busseri, Tyler, and King Most commonly cited reasons, apart from academic performance, for making judgments about the need for dismisal of a particular trainee: Ethical infractions or reasoning Problematic clinical skils development or performance Failure to respond sufficiently to remediation plans Unprofesional demeanor Concerns raised by supervisor (table continues) 19 Table 1 (continued) Date published Authors Five Most Frequently Cited Factors (first listed being the highest ranked) 2005 Rosenberg et al. Most common types of problems students observed in their peers lack of awarenes of impact on others: Emotional problems Clinical deficiency Poor interpersonal skils Academic deficiency 2006 Bogo, Regehr, Woodford, Hughes, Power, and Regehr Most common themes to emerge regarding the performance of problematic practicum students: Personal qualities: iritable, defensive, judgmental, lacking in empathy Personal qualities and their impact on behavior in the field seting: needy, opinionated Personal qualities and their impact on ability to conceptualize practice Personal qualities and their impact on practice abilities: relational and procedural components The academic and non-academic factors cited vary in the terminology used. Intrapersonal and interpersonal skils are the most common factors asociated with student unsuitability as shown in the referenced studies in Table 1. A number of risk factors can contribute to the vulnerability of counselor impairment. Olkin and Gaughen (1991) devised 16 indicators to addres when looking at student impairment: ethical violation, unprofesional conduct, suicide atempts, substance use/abuse, possible signs of a personality disorder, decreased academic performance, social inappropriatenes, poor clinical skils, references of suicide, emotional dificulties, defensivenes in supervision, evidence of mood disorder, physical ilnes, hyperactivity/hypomanic behavior, poor hygiene, and poor writing skils (Olkin & Gaughen, 1991). Acording to the ACA (2009), these risk factors often manifest themselves in burnout, compasion fatigue, vicarious traumatization, mental health conditions, substance 20 abuse, over-involvement and overwork, contagion, and relationship problems. Moreover, these risk factors reveal that impairment can exist prior to entry into the profesion and thus could be identified earlier on with efective gatekeeping practices. Counselor educators must know how to addres these factors and adhere to the ethical standards and acreditation requirements. Profesional Standards and Calls Profesional codes and acreditation standards articulate the profesional responsibility and obligation Counselor Education programs have to ases, addres, and remediate problematic behavior. These codes and standards are typicaly the first line of defense profesionals use to support research on evaluation and retention. To frame these codes and standards, this researcher began with the American Psychological Asociation (APA) which for over 30 years has provided guidance respective to the evaluation of students. APA The Guidelines and Principles for Acreditation of Programs in Profesional Psychology (2007) provided prescriptive recommendations for student evaluation. Within the acreditation domain and standards it notes that programs must have policies and procedures that govern student and intern performance evaluation, fedback, advisement, retention, and termination decisions (Domain A: Eligibility). Doctoral graduate programs must also make available policies and procedures not only to the student and interns, but to al interested parties (Domain A: Eligibility). Domain E: Student-Faculty Relations, further specifies that: 4. At the time of admision, the program provides the students with writen policies and procedures regarding program and institution requirements and expectations regarding students? performance and continuance in the program and procedures for the termination of students. Students receive, at least annualy, writen fedback on the extent to which 21 they are meting the program?s requirements and performance expectations. Such fedback should include: (a) Timely, writen notification of al problems that have been noted and the opportunity to discuss them; (b) Guidance regarding steps to remediate al problems (if remediable); and (c) Substantive, writen fedback on the extent to which corrective actions are or are not succesful in addresing the isues of concern. (p. 11) More specificaly, Section B. Internships, explicitly specifies a greater frequency of fedback, as wel as prescriptive guidance on what that fedback should encompas (Domain E: Intern-Staf Relations). It appears that the guidelines evolve based on the clasification of the student. Postdoctoral residences fedback must include: (a) An initial writen evaluation provided early enough in the program to serve as the basis for self-correction (if needed); (b) A second writen evaluation that occurs early enough to provide time for continued correction (if needed) or development; (c) Discussions and signing of each evaluation by the resident and the supervisor; (d) Timely writen notification of al problems that have been noted, the opportunity to discuss them, and guidance regarding steps to remedy them (if remediable); and (e) Substantive writen fedback on the extent to which corrective actions are or are not succesful in addresing those problems. (p. 27) 22 Residency students, upon entry into the program are imediately provided program requirements, performance expectations, writen grievance, conflict resolution procedures, and polices regarded continuation and program termination (Domain E: Resident-Supervisor Relations). These guidelines place emphasis on profesional behavior and performance; and clearly articulate programs? responsibilities to ases, evaluate, remediate and terminate students. The APA Ethical Principles of Psychologists and Code of Conduct (APA, 2002) is yet another resource that provides guidance on standards that are specific to evaluation of problematic behavior. The APA code notes that its profesionals strive to do no harm and ?safeguard the welfare and rights of those with whom they interact profesionaly and other afected persons? (p. 3). This principle speaks to the intention of gatekeeping. Further, the APA programs must maintain program descriptions that communicate the requirements necesary to satisfactorily complete the program (Standard 7.02). Student evaluation is based upon the student?s performance. When addresing student asesment and performance, a specific proces for providing that fedback should be noted. This proces for fedback is communicated at the onset of the supervisory relationship. The APA principles are specific to psychologist and are provided as a means to se what exists within similar profesions. ACA Many of the principles and standards within the ACA code paralel those of the APA. The ACA Code of Ethics (2005) outline ethical responsibilities and principles aimed to ensure profesional development so that counselors and counselors-in-training do no harm to clients. Entries in the Code outline specific behaviors that govern program responsibilities, to include counselor evaluation and dismisal. As role models for profesional behavior, counselor educators are ?knowledgeable about ethical, legal, and regulatory aspects of the profesion? (Section F.6.a.). This modeling and awarenes are critical, as a primary obligation is to monitor 23 services provided by counselors-in-training, ensuring client welfare (Section F.1.a.). This responsibility further prescribes how to monitor and ases the students. Specificaly, supervisors must ?met regularly with supervises to review case notes, samples of clinical work, or live observations? (Section F.1.a.). Thus the supervisor is evaluating the ability and appropriatenes of the services being provided by the counselor-in-training to ensure client welfare. The ethical mandate to evaluate, remediate, and endorse are outlined in Section F.5. of the Code. This section specifies that ongoing performance appraisal and evaluative fedback should be provided to counselors-in-training and documented (Section F.5.a.). The Code goes on to specify how counselor educators should addres remediation (Section F.5.b.). This evaluative proces is critical because supervisors also ?endorse supervises for certification, licensure, employment and completion of academic and/or training programs? (Section F.5.d.). This endorsement cannot be provided when supervisors believe impairment exists. Certain mandates outlined in the Code should be made aware to prospective students at the time program application is made. Prospective students should be made aware, in advance of admision, about program expectations to include: ?the type and level of skil and knowledge acquisition required for succesful completion of the training; bases for evaluation; and student and supervise evaluation and dismisal policies and procedures? (Section F.7.a.). Further, counselor education programs have a responsibility prior to admision and throughout the program to ensure students are abreast of expectations and evaluative methods. This is articulated in Section F.9. Evaluation and Remediation of Students, which is one of the most critical sections relevant to gatekeeping eforts of counselor education programs. Standards require appraisal and evaluative fedback to 24 be ongoing, thus providing an opportunity for counselor educators to be aware of addres student limitations (Sections F.9.a.; F.9.b.). When limitations are identified, Section F.9.b. further requires counselor educators to utilize consultation, be asistive, ensure due proces, and sufficiently document their decisions. The last standard contained within this section addreses personal counseling as an intervention to addres remediation. Ethical concerns have been raised about this requirement (Kaslow et al., 2007). Specificaly, concerns around balancing acountability with confidentiality and lack of research to support efectivenes of personal counseling for remediation have been identified (Kaslow et al., 2007; Olkin & Gaughen, 1991; Vasquez, 1999). Counselors-in-training are to ?refrain from ofering services when their physical, mental, or emotional problems are likely to harm a client (Section F.8.b.). Although counselors-in- training are to be aware of this mandate, counselor educators are to ensure this through gatekeeping and remediation asistance; similarly, the CACREP standards addres evaluation and dismisal of problematic behavior in students. CACREP (2009) requires that counselor education programs describe the academic unit, each program ofered, including admisions criteria as wel as the ?minimum program requirements and matriculation requirements? (p. 3). Doctoral admision criteria must include ?academic aptitude for doctoral-level study,? and ?fitnes for the profesion, including self-awarenes and emotional stability? (Sections I.D.1. & 2.). The standards further stipulate the time parameters for communication of expectations and policies. Prior to admision or at the beginning of the first term of enrollment, students should participate in a new student orientation (Section I.L.1.) and a student handbook provided inclusive of a student retention policy that explains student remediation and dismisal procedures of the program (Section I.K.2.d.). Student retention policy as defined by the standards is a 25 ?policy by which program faculty members evaluate each student for academic, profesional, and personal fitnes to continue in a counseling program.? The academic performance, profesional development and personal development of counselors-in-training must be asesed and this asesment must be done throughout the program (Section I.P.). Programs must have a protocol for evaluating and addresing problematic behavior to ensure acreditation by the CACREP. Additionaly, faculty are required to asist with transitioning students out of the program when evaluation has deemed it necesary (Section I.P.). Olkin and Gaughen (1991) found that a lot of programs relied on students to self select transitioning out as opposed to the program recomending students to leave. The transition of students is a critical element when considering institutional and individual liability as evidenced in a landmark case against Louisiana Tech University where it was argued that the university had an obligation not only to the student but also to the public to ensure program graduates were competent (Kerl, et al., 2002). Clearly there is a profesional and ethical obligation for programs to protect clients. Profesional codes, acreditation standards, and the profesion echo this need. Profesional Calls In addition to profesional codes and acreditation standards, the profesion mirors the sentiment that it is incumbent upon programs to ases, evaluate, and remediate problematic behavior. Problematic behavior that is demonstrated through skil deficiencies should be anticipated during the preparation of counselors (McAdams & Foster, 2007) thus programs should be proactive in its approach to dealing with this isue (Olkin & Gaughen, 1991). Brear et al. (2008) se the chalenges of gatekeeping as twofold in that faculty must develop relevant and explicit criteria to measure students and have a framework in which gatekeeping can work 26 within. Dufrene and Henderson (2009) echo these sentiments in that the chalenge comes in ?identifying and implementing useful supervision strategies.? Faculty are responsible for replenishing the profesion with knowledgeable and skiled profesionals. A failure to equip students with the necesary skils can result in unwelcomed ramifications (Custer, 1994). Corey, Corey, and Calanan (1998) note beter identification is necesary as wel as efective remediation. This is underscored by McAdams and Foster (2007) who se efective remediation practices as an ongoing need that should reflect fair and just opportunities. In their own experiences, the College of Wiliam and Mary highlight the need for faculty to create and maintain a framework for evaluation (McAdams & Foster, 2007). These gatekeeping methods begin with operational definitions, expected behaviors, acesible policies and procedures, continual evaluation, and remedial and dismisal protocols (Olkin & Gaughen, 1991). In addition to the needs as ilustrated by the profesion, students are concerned about gatekeeping. A Mearns and Alen (1991) study found that 95% of graduate students experienced peers with problematic behaviors. Oliver et al., (2005) report the problematic behavior encountered by peers caused (a) disruption of clas time, (b) dificulties applying the cohort model during supervision, and (c) chalenges related to individual learning. These disturbances can further impact the students experience and regard for the profesion and faculty (Oliver et al., 2004; Mearns & Alen, 1991). Left unaddresed these experiences can contribute to negative emotionality and adversely afect the educational climate. Despite these ramifications and student desires to uphold ethical standards, students felt they lacked the knowledge on how to addres problematic behavior (Mearns & Alen, 1991). Similarly, students as wel as profesionals struggle with voicing concerns about problematic peers because of the potential for negative repercussions (Thomas, 2010). Notedly, this leaves the magnitude of responsibility on 27 faculty. Students have concerns about problematic behavior being inadequately addresed by their colleges and universities. Acording to Oliver et al. (2004) a study found that students did not believe problematic behavior was adequately addresed at their colleges and universities nor was the topic discussed during course enrollment. In Rosenberg et al.?s (2005) exploratory study, students further indicated that their programs had no established procedures for dealing with problematic behavior. Similarly, Oliver et al. (2004) found that 53% of participants in their study were not aware of the policies and procedures to addres problematic behavior. Further, students felt that there was not an adequate outlet to addres concerns about problematic behavior with faculty (Rosenberg et al., 2004). This exposure to problematic behavior and uncertainty as to how to addres it can contribute to a precarious environment. To ensure adherence to profesional codes, acreditation standards, field and student expectations, gatekeeping should be on the forefront of the profesion. We are obligated to the profesion and to those it serves to ensure fitnes and this begins prior to program admision. Profesional codes and acreditation standards clearly communicate the responsibility and obligation counselor education programs have to aces, addres, and remediate problematic behavior. The literature further supports the need to addres problematic behavior. As noted by Wilkerson (2006) and Dufrene and Henderson (2009), these standards and guidelines are void of the specifics on how to cary them out, thus, each program is responsible for developing its own policy and action. Counselor Education Programs? Response to Problematic Behavior In his monumental article in 1975, J. L. Bernard discusses the dismisal of clinical students in psychology, which provided foundational guidelines for programs to build upon. The 28 guidelines require that within program descriptions students be made aware that they can be dismised for the program for ethical violations and/or unsuitability for the profesion; routine writen evaluations that objectively evaluate personal, clinical, profesional, and interpersonal functioning; when problematic behavior exists, a writen remediation plan is acomplished; and if improvement is not sufficiently made within the alotted time, the student is advised of dismisal hearing and time is alowed to prepare for the meting and discuss the consequences (O?Haloran, 1997). As noted by Bernard (1975), counselor education programs must have sound policies and procedures in place to addres problematic behaviors that impede students. McAdams and Foster (2007) note that standards fal short in specifying the type and extent of remediation necesary. Multiple models exist as a framework for programs to use for remediation. These models are presented to addres how programs have approached retention and dismisal. Knoff and Prout (1985) offer procedural guidance for psychology programs that may help shape remedial proceses across disciplines. The first step in this proces is to develop a policy statement or formal policy that addreses the student?s development. Moreover, the policy should detail the expected behaviors, parameters for not meting the expected behaviors, and place emphasis placed on adherence to ethical standards. Subsequently, the policy should be provided to students upon entry into the program. Integral to the policy is the evaluation and review of students, inclusive of academic, skil acquisition, personal and profesional progres, which should occur on an annual basis (Knoff & Prout, 1985). Further this model suggests that al relevant program faculty or a designated commite conduct the evaluation. Emphasis should be placed on practicum, internships, and field experiences. An interview format and/or writen fedback can be provided to communicate the evaluation findings. If an area of concern has 29 been identified, students must be formaly notified and a plan to remediate those concerns is developed with the students input. This in turn places the student on probation. Four options are available to faculty when revaluating the student: (1) continuation in the program, (2) continued probation and remediation, (3) counsel the student out of the program, and (4) dismisal from the program. If the later option is determined, writen notification of the reason for impending dismisal is required and due proces provided for the student to request a formal review of the mater. Frame and Steven?s-Smith (1995) established a monitoring and dismisal proces that has been widely used to shape remediation practices. The Frame and Stevens-Smith model is a thre step model involving evaluation, review, and outcome that addreses: being open, flexible, positive, cooperative, wilingnes to use and acept fedback, aware of impact on others, able to deal with conflict, able to acept personal responsibility, and able to expres felings efectively and appropriately (Frame & Stevens-Smith, 1995). Frame and Stevens-Smith, profesors at the University of Colorado at Denver, utilize the Personal Characteristics Evaluation Form to evaluate the students against the nine aforementioned characteristics. Students are asesed based on the characteristics in each course they are enrolled in at midterm and at the semester?s end (Frame & Stevens-Smith, 1995). An alternative to Frame and Stevens-Smith has been developed by Baldo and Softas-Nal (1997). Baldo and Softas-Nal believed that the Frame and Stevens-Smith model placed the faculty member(s) in a dificult position to potentialy become the target of the student?s frustration over an undesirable evaluation. Their model provides for a faculty review commite and utilizes the entire counseling faculty for evaluating student progres. The University of Northern Colorado (UNC) utilizes this model for its student review and retention. On a yearly 30 frequency, program faculty met to ases student progres. The revaluation options available to faculty are along the same premise as those purported by Knof and Prout (1985). When progres is unsatisfactory, students are notified and a meting is established with their advisor to discuss the review and the procedures necesary for remediation. If probation is required, a writen remediation plan is collaboratively developed by the student and the advisor and requires approval from the retention commite. A copy of the plan, along with the student and advisor signature is provided to the student and placed within the student?s file. Southwest Texas State University counseling faculty developed the Profesional Counseling Performance Evaluation (PCPE) to evaluate, communicate, and remediate problematic behavior (Kerl et al., 2002). The PCPE is a part of al experiential courses and optional for use within didactic courses. To this end, it is important to note that just because a counselor-in-training does exceptionaly wel on writen and oral course work, they could fail a course based on the PCPE evaluation for that course. Such an evaluation could result in the initiation of a remediation plan or referal to a faculty review commite. Kerl et al. (2002) further indicate that utilizing the PCPE from entry into the program and consistently throughout matriculation reduces gateslipping potential. Furthermore, the PCPE has withstood legal dismisal chalenges. McAdams et al. (2007) outline what is done at The College of Wiliam and Mary concerning retention and dismisal. Specificaly they utilize the Profesional Performance Review Policy (PRP), which is a protocol to evaluate and addres problematic behavior (McAdams et al., 2007). The PRP measures students against the following criteria: opennes to new ideas, flexibility, cooperativenes with others, wilingnes to acept and use fedback, awarenes of own impact on others, ability to deal with conflict, ability to acept personal 31 responsibility, ability to expres felings efectively and appropriately, atention to ethical and legal considerations, and initiative and motivation. The methods by which to ases each criteria are provided in descriptive terms and applied to a one-to-five Likert scale (McAdams et al., 2007). The PRP is introduced to students early on, at new-student orientation and it?s also included in the student handbook. Introducing these policies early on is beneficial and esential to the policies addresing problematic behavior. The PRP in a 2006 CACREP reacreditation visit was noted as an exemplary policy and provided to be beneficial when the university was chalenged in federal court for dismisal of a student (McAdams et al, 2007). Moreover, having a uniformed, predetermined, and published policy aided the litigation for the university. Critical to Wiliam and Mary?s dismisal decisions is a vote from the full counselor education faculty (McAdams et al., 2007). Once this vote is acomplished, the recommendation is reviewed by the asociate dean and subsequently by the dean who makes the final decision. Specific to this university?s policy, a student has the opportunity to addres the dean regarding the decision. Building upon the models of Frame and Stevens-Smith and Baldo and Softas-Nal is a model offered by Lumadue and Duffey. The model ofered by Lumadue and Duffey (1999), utilized at Southwest Texas State University difers from previous models in that it begins with the admisions proces. A copy of the Profesional Performance Fitnes Evaluation (PFE) is included within prospective student?s admision package, thus placing an emphasis on evaluation at the onset of the student?s academic carer (Lumadue & Duffey, 1999). The evaluation criteria contained within the PFE goes beyond the abstract characteristics of Frame and Stevens-Smith model and include specific behaviors (Lumadue & Duffey, 1999). Wilkerson (2006) synthesized the common components of Baldo and Softas-Nal, Frame and Stevens-Smith and Lumadue and Duffey as: 32 a. policies and procedure manuals specifying program expectations b. systematic proces for regular student evaluation and critique c. outline of procedures used to identify and notify students when problematic behaviors exist d. step-by-step procedures to document student concerns e. sequences for the development of time-based and outcome-focused plans to addres problematic behavior f. follow-up review protocol to determine student?s future status in the program g. formal sequences to follow if dismisal is indicated h. elaboration of student?s rights and responsibilities for confidentiality and appeals proces. A more recent model has been presented by Dufrene and Henderson. Dufrene and Henderson (2009) purport that previous models focus heavily on dismisal rather than remediation and therefore they provide a model that looks specificaly at how remediation should occur. Based upon their model, the proces of remediation begins with a discussion betwen student?s supervisors and/or clinical faculty coordinator. Once a collaborative decision is reached among faculty and supervisor, an individual remediation plan (IRP) is developed by the university supervisor based upon the student?s problematic areas (Dufrene & Henderson, 2009). The faculty clinical coordinator, supervisors, and the student met to discuss the purpose of remediation, due proces, informed consent, and the IRP are reviewed. During this meting, an opportunity for collaborative input is provided to the student and if necesary the IRP is revised. Consultation is integral to this proces, because other counselor educators are consulted throughout the proces (Dufrene & Henderson, 2009). These authors indicate that confidentiality 33 is not implied due to the potential legal ramifications that could ensue (Dufrene & Henderson, 2009; McAdams et al., 2007). The elements contained within the IRP are profesionalism of the trainee, counseling skils of the trainee, and documentation of clinical work by the trainee (Dufrene & Henderson, 2009) which are consistent with problematic behaviors experienced by counselors-in-training (Li et al., 2008). Specific directives are contained within each element. The elements of the IRP are based upon the individual needs of the counselor-in-training. Similar to the PRP, a Likert scale is utilized to ases each item with the IRP. IRP?s are time specific and are updated wekly to reflect the supervision sesion, and movement toward the indicators contained within. Additionaly, notes are maintained of the supervision sesion and faculty and student signatures are required. Utilization of an IRP is just one aspect of gatekeeping. Although a survey by Olkin and Gaughen (1991) revealed that a large number of programs were void of writen gatekeeping policies and of those that had policies few utilized formal evaluations. Multiple gatekeeping models exist for counselor education programs to utilize to develop sound policies and procedures to addres problematic behavior. The aforementioned models provide a framework that some programs have implemented; however, additional recommendations are provided. If remedial practices have been found to be inefective and dismisal has to be pursued students must be informed about their right to appeal. Knof and Prout (1985) provide a proces for dismising students within psychology programs that might inform the counselor education dismisal proces. Formal policy should addres the role of personal and profesional development, as wel indicate adherence to ethical standards; evaluation and review should be ongoing with fedback given on at least an annual basis; remediation plans should behavioraly 34 define problems, identify the goals and expected behavior, indicated methods to reach the goals, identify date to atain goals and/or date for revaluation and be provided to the student (Knof & Prout, 1985). As consideration is given to revaluation Knoff and Prout (1985) suggest options such as continuation in program, continued probation, counsel student out of the program and/or dismisal. To understand the efectivenes of these recommendations, further, evaluation is necesary to having sound remedial practices (Frame & Stevens-Smith, 1995). Thus programs should consider evaluation as a means to enhancing and refining practices and alow the data to inform changes. Specific guidance from the APA, ACA, and the CACREP has been provided. This review of the literature has highlighted various models programs have utilized to addres remediation and dismisal. Additionaly, policy and procedure recommendations have been provided. Next, we wil look at what programs are doing at various intervals to addres problematic behavior. Pre-Admision Gatekeeping as a proces involves student selection. At time of program application, problematic behavior may be evident. Thus, counselor educators begin asesing suitability through a systematic proces prior to admisions. Many programs have developed admision criteria or methods to ases for indicators of problematic behavior, which typicaly begin with a review of undergraduate grades and standardized test scores. Based on a qualitative study of CACREP master?s level programs, Ziomek-Daigle and Christensen (2010) provide a four-phase gatekeeping proces. The pre-admision phase of gatekeeping involved reviews of applicants? academic aptitude and interpersonal interaction. The academic aptitude criterion includes a review of standardized test scores, grade point 35 average (GPA), recommendation leters, education, work experience, and a goal/personal statement. It is noteworthy that GPA requirements vary from university to university as wel as standardized test scores. Many programs have developed admision criteria or methods to ases for indicators of problematic behavior, which typicaly begin with a review of similar academic aptitude criteria. However, Eriksen and McAulife (2006) note that this review alone is inefective in predicting counseling skils. To acommodate this concern, some colleges and universities utilize proceses that involve interpersonal interaction. The interpersonal interaction criterion includes individual/group interviews with faculty, role play vignetes, writing samples, and an informal sesion. Baldo et al. (1997) encourages utilization of a faculty review commite to facilitate gatekeeping practices. This commite can be reflected in the initial interview proces. Interviews alow exploration of interpersonal styles and interaction styles. Interviews involving multiple faculty members alow some evaluation of personal characteristics. Role-plays have been used to ases multiculturalism and as a means to gauge cultural sensitivity (Ziomek-Daigle & Christensen, 2010). Informal met and gret sesions often involve current students within the program and alow for multiple interactions (Ziomek-Daigle & Christensen, 2010). Eriksen and McAulife (2006) note that personal characteristics of counselors have been connected to client outcomes thus the need to gauge empathy, cultural sensitivity, communication skils, and ability to build rapport. Further, Olkin and Gaughen (1991) suggest that interpersonal and interpersonal fitnes be considered. Further the pre-admision procedures also alow faculty to communicate the program expectations, means of evaluation, and provided writen program aterials and manuals. This ensures programs satisfy requirements of acrediting bodies and profesional bodies. Southwest Texas State provides prospective students a copy of the PFE, which is an evaluative tool 36 utilized throughout their program. Gatekeeping strategies begin prior to admision, though these strategies may not reveal problematic behavior. Reliance on preadmisions screning and admisions criteria is not enough. Therefore it is necesary for gatekeeping to be ongoing and continuous throughout the program. Post-Admision Gatekeeping is an ongoing and continuous proces that begins at pre-admision and continues through program exit (Brear et al., 2008). Monitoring and evaluating student?s fitnes for the profesion is the retention aspect of gatekeeping. Ziomek-Daigle and Christensen (2010) note that because of the continual proces of evaluation, some student?s admitance is only provisional until certain criterion are met. In the post-admision phase of gatekeeping as outlined by Ziomek-Daigle and Christensen (2010) the academic aptitude criterion includes a review of counseling skils, academic performance, and standardized tests. Continued evaluation is occurring during clinical course work, practicum, and internship experiences. Course work and grades is one means to evaluating students during the program. Specific emphasis is often placed on skils courses, multicultural courses, and application of ethical principles throughout course work. Integrating discussions on ethics, standards, and university policies and procedures into coursework is integral to ensuring students are abreast and informed (McAdams et al., 2007). Skil acquisition for counselors-in-training extends beyond the clasroom and into practicum experiences that involve supervision, direct service delivery, and teaching. Olkin and Gaughen (1991) looked at evaluation of graduate students in clinical programs and found that the majority of programs identify problematic behavior through academic course work (65%). The other means of identification occurred through practicum or other clinical course work followed 37 (54%), faculty referal (36%), student evaluation (28%), off-campus supervisors (23%), and GPA (Olkin & Gaughen, 1991). The ongoing asesment and evaluation that occurs during clinical experiences often reveals problematic behavior (Dufrene & Henderson, 2009). The interpersonal interaction criterion described by Ziomek-Daigle and Christensen (2010) includes supervision, practicum/internships, formal discussions, leters of recommendation/endorsement, and supervisor?s fedback. Supervision as defined by Goodyear (as cited in Dufrene & Henderson, 2009) is ?an experienced profesional mentoring and providing direction, training, fedback, and evaluation to novice supervise?s.? By nature of design, supervision is a means to ases and evaluate student proficiency and fitnes for the profesion. Supervision alows for faculty to measure student growth, personaly and profesionaly as wel as to observe if constructive fedback is received and implemented (Ziomek-Daigle & Christensen, 2010). Additionaly, annual evaluation reports, portfolios, and writen exams have been used to ases counselors-in- training. Annual evaluation reports take into acount multiple competencies and provide a summative review of the student. These evaluations can come from multiple departmental faculty and alow for the student to do a self-asesment. Program faculty from the University of North Carolina met yearly for student review and discuss the progres of students (Baldo & Softas-Nal, 1997). Student evaluation has often taken the form of writen exams and comprehensive tests. The more traditional approach of utilizing writen exams is an objective measure that doesn?t provide the same type of formative evaluation as a direct observation of a clinical experience. Gaubatz and Vera (2002) advocate that faculty ases content knowledge as wel as interpersonal 38 and intrapersonal fitnes. A multifaceted approach is being used as an additional means to evaluate student progres and development. Portfolio asesment as defined by Arter and Spandel (as cited in Carney & Cobia, 1996) is a ?purposeful collection of student work that tels the story of the student?s eforts, progres and achievement in a given area.? This qualitative approach to evaluation provides documentation of a student?s knowledge, skils, abilities, and personal development in various competencies across multiple contexts and situations (Carney & Cobia, 1996). The use of portfolios alows faculty to evaluate students in areas not asesed through standardized testing and may benefit students who are poor test takers. Further, it alows for comprehensive summative fedback for the student and may reflect on the totality of one?s learning (Carney & Cobia, 1996). Programs are beginning to forego traditional means of asesment for this more holistic approach. Evaluation should be ongoing (ACA, 2009; CACREP, 2009; Knof & Prout, 1985; Wilkerson, 2006) and the results of these evaluations should be made known to al program faculty and the students that are being evaluated (Wilkerson, 2006). Specific examples might include end of semester evaluative reviews, advisement records, and leters of action. Based on Frames and Stevens-Smith?s model, it is suggested that faculty rate students at midterm and at the end of semester every semester (O?Haloran, 1997). The described elements of the post- admision phase of gatekeeping aim to satisfy the Section F.5. of the Code which requires ongoing performance appraisal and evaluative fedback. These elements often reveal the need for remediation. Remediation, Intervention, and Dismisal In an atempt to provide guidance and structure, acrediting bodies define the operational standards of the graduate programs, and require remediation once problematic behavior is 39 determined. McAdams and Foster (2007) contend that remediation is instruction during the progres of a course (or study of a body of material) in acquisition of basic prerequisite skils that are esential for eventual succes in the course. Remediation is used to addres problematic behavior in counselor education. Remedial instruction as conceptualized by Ross (as cited in McAdams & Foster, 2007) is ?instruction during the progres of a course in acquisition of basic prerequisite skils that are esential for eventual suces in the course.? Remediation is contingent upon thorough asesment and evaluation. The ongoing evaluation that is required provides opportunity for problematic behavior to be addresed. When remediation is deemed necesary, counselor educators must asist supervises in securing remedial asistance. Once the need for remediation has been identified, common elements of that proces as outlined by Wilkerson (2006) include: repeating specific course, denial of admision to course, therapy, increased supervision, specific goals in supervision relative to the problematic behavior(s), reduction of amount of clinical services being delivered if in a practicum or internship experience, additional course work or courses, writen warnings, formal probation, leave of absence, disciplinary action, and/or dismisal. Russel and Peterson (2003, as cited in Li et al., 2008) note the following as ways to remediate: ?tutoring, specific seminars, extra coursework, peer support groups, special asignments, referal to an ombudsperson.? The remediation phase of gatekeeping as outlined by Ziomek-Daigle and Christensen (2010) includes intensified supervision and personal development. Intensified supervision could involve increased supervision requirement, reasignment, and a contract. The increased supervision requirement consists of additional clinical tapes for supervision and review, extra supervision sesions, and repeating a course. Students may also be reasigned to another supervision supervisor and/or faculty member when there is concern about personality conflicts 40 and ability to efectively reach a student (Ziomek-Daigle & Christensen, 2010). The methods of remediation are documented in a remediation plan and/or contract. Defining who has aces to remediation plans is another element that?s been suggested by Wilkerson (2006). Further, students must be informed about the potential consequences of not acomplishing goals and objectives within the remedial plans. Plans provide documentation to support the isues to be addresed and the interventions utilized to addres the isues. Faculty and student signatures should be gained on communication that addreses a student?s problematic behavior and the remediation proces that wil ensue (McAdams et al., 2007; Wilkerson, 2006). Personal development involves leave of absence, personal counseling, and counseling to withdraw (Ziomek-Daigle & Christensen, 2010). A leave of absence for a semester may be merited for students to take time to aces themselves and to resolve isues that contributed to problematic behavior being identified. Oftentimes, personal isues that contribute to remediation are resolved through personal counseling and therefore, programs recommend counseling as a requirement of remediation (Ziomek-Daigle & Christensen, 2010; Frame & Stevens-Smith, 1995; Knoff & Prout, 1985). Since the need for therapy is identified as a consideration to addres problematic behaviors, programs must have referal options available for the student for such services. Referal options should include not-for profit agencies, for-profit agencies, and independent practitioners. Additionaly, consideration should be given regarding the need for the student to consent to release specific information to the program that might be of benefit to acomplishing goals and objectives of the remedial plan. Despite means to addres problematic behavior, students may reject the notion and opt to withdraw from the program. Conversely, faculty may communicate with the students their concerns and determine the student should be counseled to withdraw from the program (Ziomek-Daigle & Christensen, 2010). 41 The last phase of Ziomek-Daigle and Christensen?s (2010) model addreses remediation outcome. Succesful remediation occurs when students implemented the remediation plan and changes were made that result in a continuation in the program. Unsuccesful remediation occurs when marked diferences are not noted despite having a remediation plan or when students fail to complete the plan, resulting in dismisal, self-selection/leave program, and carer advisement. Indiferent/neutral remediation outcomes would consider the institutional and individual liability of students whose eforts resulted in marginal improvements and putting forth the bare minimum to acomplish remediation plan. If remediation is not succesful, counselor educators are ethicaly bound to recommend dismisal from the program and provide guidance in choosing another program. Further explicit examples and explanations should be provided about instances for which students would be dismised from the program (Wilkerson, 2006). The code is explicit in its mandates for counselor educators when preparing counselors- in-training for the profesion. It encompases within the mandates the rights that students should be aforded throughout Section F. Further, F.5.b. requires supervisors to sek consultation and document decisions to dismis or refer supervises for asistance. To that end they ensure that supervises are aware of options available to them to addres such decisions. Ethical mandates and requirements from acrediting bodies have clearly articulated what the expectation is. Sumary Despite having multiple methods to utilize for asesment and evaluation, research findings indicate there is a reluctance to asume the role of gatekeeper (Brear et al., 2008). This reluctance is atributed to the proactive stance that is necesary to adequately addres students as wel as the lack of definitive criteria to addres this responsibility (Brear et al.). Moreover, gatekeeping practices vary across programs and not al gatekeeping is sen as equal (Bradley & 42 Post, 1991). To that end, this study proposes to relieve this reluctance by identifying the common themes in how acredited counseling programs define problematic behavior, the methods employed to ases problematic behavior, and the proceses used to remediate problematic behavior of counselors-in-training. Providing this framework may help guide and enhance gatekeeping policies. In this next chapter, the methodology for this study is discussed. 43 CHAPTER II. METHODOLOGY The intent of this study was to examine how CACREP acredited counseling programs define, ases, and remediate problematic behavior of counselors-in-training. The foundation of this study is rooted in factors identified in ethical guidelines (ACA, 2005) and profesional standards (CACREP, 2009) as stated requirements of counselor education programs. These guidelines and standards inform the proposed research questions of this study. This chapter describes the research proces including the participants, measures, procedures, and data analysis. Sample The present study focused on an analysis of the content of published and acesible program policies and procedures. The sample for this study was identified through the CACREP, 2009, Directory of Acredited Programs. The sample was restricted to doctoral counselor education programs (N = 58). It was anticipated that doctoral policies would encompas information necesary to addres the research questions. Milennial generation learners typicaly go to the internet to aces information and therefore only electronicaly acesible policies and procedures were included in this study. The programs included a regional representation of programs throughout the United States. The programs were randomly selected. However, one program was omited because of the researcher?s afiliation with the program. When aces to each program was atempted utilizing the links available through the CACREP Directory, ten programs did not appear to have electronicaly acesible doctoral 44 counselor education program handbooks. For these reasons, twelve programs were omited from the sample. Forty seven programs remained for inclusion in the sample. In qualitative research, ?there is no universaly acepted set of criteria for selecting the size of a sample? (Krippendorf, 1980, p. 67). To ensure the sample size is fuly representative of the sample, the projected sample size was 30 programs, which is consistent with Creswel?s (1998) suggested range of 20 to30. Measures The use of qualitative methods has been demonstrated within the field of counseling and counselor education as a ?goodnes of fit? (Ziomek-Daigle & Christensen, 2010). Subsequently, content analysis, a research methodology used within qualitative analysis was used in the present study. Content analysis as defined by Krippendorf (1980 p.21) is a research technique that alows the researcher to make replicable and valid inferences from data to their context. As a tool, content analysis, can provide knowledge, insight, and represent the facts (Krippendorf, 1980). Weber (1990) concludes that content analysis alows for inferences to be made about the mesage, the mesage sender, or the audience of the mesage. Content analysis provides a systematic and unobtrusive method for gathering data and isolating themes. Word-frequency analysis and interpretive coding of narative responses are two procedures synonymous with content analysis (Vac & Loesch, 1993). Interpretive coding takes words and phrases and clasifies them into content categories representing major ideas or themes (Vac & Loesch, 1993). Computer software can asist content analysis making it a reliable and simple proces in comparison to human interpretive coding (Webber, 1985). This content analysis utilized 45 interpretive coding of narative responses. The questions used to analyze the policy data of the CACREP-acredited programs are as follows: 1. What are the common themes across definitions of problematic behavior in CACREP- acredited doctoral counselor education programs? 2. What are the common themes in how problematic behavior is asesed in CACREP- acredited doctoral counselor education programs? 3. What are the common themes in the proceses and procedures identified for remediation of problematic behavior in CACREP-acredited doctoral counselor education programs? Procedures Qualitative researchers note the importance of epistemology when clarifying researcher bias from the onset of a study (Creswel, 1998). Qualitative researchers are not disconnected from their research; rather the qualitative researcher addreses their interaction betwen the data (Maione, 1997). Therefore, it is necesary for this researcher to comment on my ?past experiences, biases, prejudices, and orientations? that wil likely shape my interpretation of the data (Creswel, 1998, p. 202). My relationship to this topic is as follows. I am a doctoral student in Counselor Education in a CACREP-acredited program. I have a master?s degre in counseling and psychology from a university that was not CACREP-acredited at the time of my enrollment. At the beginning of my masters program, I utilized services in the university writing center, which at that time could have been deemed an informal means of remediation. Moreover, I know individuals who have been afected by the remediation proces. I first became familiar with the concept of problematic behavior when I began exploration of this topic area for research potential. 46 Clearly stating my epistemological stance is a means to establish credibility, in addition to providing some level of visibility with the data used to develop this study. Additionaly, a thorough description of the research is provided to add to the transferability of this study. Transferability implies the results of this research can be generalized or transfered to other cases studied and is a means to establish trustworthines. Prior to data collection, this author consulted with the Institutional Review Board (IRB) to determine if IRB approval was necesary for this study. It was found that IRB approval was not required for this study because this study involved use of information that was acesible in the public domain. The programs for which data would be obtained were identified in the following manner. Prospective college students utilize the internet as a tool for virtual tours, to sek information about prospective programing and to complete the admisions proceses (Venegas, 2007). Thus, it is commonplace for students to aces program policies and procedures electronicaly. With internet usage becoming a necesary tool for students, it is important that these resources are acesible electronicaly. A list of doctoral counselor education programs (N = 58) acredited by CACREP was obtained from the CACREP 2009, Directory of Acredited Programs, published on the CACREP website. The directory provided a means to readily aces information by external reviewers (e.g., potential applicants). The list was captured, copied, and saved to an external location as a Microsoft Word file. The projected sample was 30 programs; therefore, each program was keyed into an electronic randomizing program at ww.random.org to electronicaly randomize the sample, providing for an equal chance for selection (Neuendorf, 2002). Each program was numericaly coded to protect the identity of the programs in the sample. This coding was employed so 47 individual programs were not identifiable, providing a means to increase understanding about the policies doctoral counselor education programs employ. One program was struck from this list because of the researcher?s afiliation with the institution. The remaining 57 program websites were acesed in a cursory search on December 9, 2010 to determine if policies and procedures were readily acesible electronicaly. This search was utilized as a means to narow the number of programs to be included in the sample. This search initialy revealed that 14 programs did not have readily acesible information. In cases where information was not readily acesible, these programs were noted on a list of non-availability. Forty-thre program policies and procedures were found, primarily in programatic handbooks. These program handbooks were electronicaly captured and stored on the personal computer of the principal researcher. The principal researcher was the only person who maintained aces to the data. The data was also stored electronicaly on one auxiliary storage flash drive belonging to the principal researcher, which was stored in a locked desk drawer belonging to the principal researcher. The data wil be retained for one year after the date of the study. Al data sheets wil be shredded and content on the computer and the flash drive erased at that time. On December 17, 2010 a verification search was done on the 14 websites of the programs that did not initialy yield policies and procedures. The verification search involved a terminology search of the program websites, utilizing terms such as evaluation, remediation, retention, counselor education handbook, and counselor handbook to asist in finding the policies. This verification search ensured that al programs having acesible materials were included for consideration in this study. The verification search yielded 4 additional policies and procedures, providing for a total of 47 programs for potential analysis. Initialy, this researcher 48 proposed to review 30 policies; however, after additional consideration it was determined that al 47 electronicaly acesible policies would be included in this study. Prior to beginning the content analysis, the principal researcher reviewed policies for program #57 to identify categories. Holsti?s method as cited in Neuendorf (2002) recommended two coders code the same unit to show agrement which contributes to reliability. Therefore, al identifying information was removed from the policy and a copy of the policy for program #57 was provided to a second reviewer. Asisting with the determination of the categories for the content analysis was a second reviewer with a counselor educator background. The second reviewer reviewed the policy for program #57 to identify categories. The results of the primary researchers? analysis was compared to that of the second reviewer until there was mutual consent, yielding the categories that would be used for the content analysis. Two additional counselor educators reviewed the mutualy agred upon categories prior to the content analysis of policies. Utilizing additional researchers in the testing of codes can be considered researcher triangulation. Triangulation is designed to ?support a finding by showing that independent measures of it agre with it or, at least, do not contradict it? (Miles & Huberman, 1994, p.266). Triangulation was used to enhance the credibility and trustworthines of these findings. Data was collected from forty-seven programs (53%) until there was a replication of themes across the data and within the research questions. The data collected for this research included the site addres and the acesible program handbook. Each policy was transfered to ATLAS.ti, a qualitative data analysis software program, which scanned the document for the semantic units based on the defined categories. It should be noted that a semantic unit might be represented in more than one coding category. Based on the content retrieved from the analysis, the content was asigned to a primary category based on the predetermined codes. The following 49 category codes were utilized: defining terminology, how problematic behavior is asesed (i.e. frequency), who aseses, and if a formal tool is used or if it is based on categorical information, and the proces of remediation once problematic behavior is identified. Data Analysis This study employed content analysis to analyze policies and procedures addresing problematic behavior in doctoral CACREP acredited counselor education programs. Content analysis as defined by Weber (1990) is a research methodology that utilizes a set of procedures to make valid inferences from text. Content analysis helps compres large volumes of words into fewer content categories based on the coding rules developed by the researcher (Stemler, 2001). Weber (1990) further indicates that of the many uses for content analysis, it can be used to ?describe trends in communication content? (p. 9). Because of the proliferation of computers to aid research, software is available to analyze large amounts of textual data. Weber (1990) notes that computer-aided content analysis is beneficial in that text is easy to manipulate, it can count the occurrences of words and phrases, and the researcher can easily search through text to retrieve portions of text meting a specific criteria. Words and themes comprise the coding units for analysis. Statements within the policies and procedures were coded for emergent themes. Many codes were subsumed under a more general category to reduce the exorbitant amount of categories. After al the policies were listed and categories asigned, a final review of the categories was checked. Sumary In this chapter, an overview of the present study was provided, focusing on the sample, measures, procedures, and data analysis procedures. In summary, this study was acomplished by obtaining and reviewing publicaly acesible information from doctoral CACREP acredited 50 counselor education programs. This study employs qualitative methods to examine how programs define, ases, and remediate problematic behavior. Study results are described in Chapter Four, followed by a discussion of the findings in Chapter Five. 51 CHAPTER IV. RESULTS The purpose of this study was to examine how CACREP-acredited counseling programs define, ases, and remediate problematic behavior of counselors-in-training. Doctoral counselor education programs were identified using the 2009, CACREP Directory of Acredited Programs (CACREP, 2009). Data collection procedures focused on identified CACREP acredited Doctoral Counselor Education programs that had program policies and procedures on evaluation of students and remediation posted electronicaly and acesible to potential students. The CACREP standards require that programs make this information acesible to potential applicants as part of the proces of informed consent in the admision and application proces (CACREP, 2001, 2009). The researcher evaluated the policies and procedures, specificaly looking at the terms used to describe problematic behavior, how problematic behavior is asesed, and how it is remediated. As described in the procedures section, this proces was reviewed by an external reviewer. This required agrement about the reviewed terms and identification of themes. The specific proces questions that were used to ases the information provided by programs included: 1. What are the common themes across definitions of problematic behavior in CACREP-acredited doctoral counselor education programs? 2. What are the common themes in how problematic behavior is asesed in CACREP- acredited doctoral counselor education programs? 52 3. What are the common themes in the proceses and procedures identified for remediation of problematic behavior in CACREP-acredited doctoral counselor education programs? This chapter includes a discussion of the sample and the qualitative results across these proces questions. Demographics The total number of potential doctoral CACREP acredited programs, who met the qualifications of this study and had web addreses, was 58. Forty-seven (N = 47) programs were analyzed in this study representing twenty-five (25) states. A list of the analyzed programs are available in Appendix A. Eleven (11) doctoral CACREP-acredited programs were not analyzed in this study. One (1) program was excluded because of the researcher?s relationship to the university. Ten (10) other programs were excluded because policies were not readily acesible on the internet. CACREP acreditation for the Counselor Education programs in this sample ranged from les than one (1) year to thirty-one (31) years of acreditation, with the average number of years of acreditation being fiften (15) years. Results Themes for each question are presented in order of prominence, those obtaining the most responses are reflected first with those with les prominence, following. Supportive textual data is displayed for each research question. Questions are marked with a Q followed by a P for policy, along with a number that corresponds with the policy (ex.Q1P1 was policy one?s textual data that supports question one). 53 Themes Across Definitions of Problematic Behavior Research Question 1 explored themes corresponding to definitions of problematic behavior. Table 2 provides a framework for looking at the most frequently reported terms used to label or define problematic behavior. The analysis indicated that no policies in Counselor Education programs use the term problematic behavior even though this is a recommended term in profesional literature. Only two programs used the term problematic. Since no single term was dominant, similar terms could be collapsed. The most frequently used term within these parameters was competence, followed by deficits, fitnes, and impairment. An analysis of the responses indicated that fitnes may paralel the use of the term suitability. Table 2 Words Used to Define Problematic Behavior Category Terminology Code % Used (N = 47) Policy Competence Competence Competency Competent Competently 3 (6%) 3 (6%) 2 (4%) 1 (2%) 26, 34, 55 1, 27, 31 17, 41 45 Deficits Deficiencies Deficiency Deficient 3 (6%) 2 (4%) 1 (2%) 33, 29, 48 42, 48 48 Impairment Impairment Impediments 4 (9%) 1 (2%) 4, 15, 32, 51 50 (table continues) 54 Table 2 (continued) Category Terminology Code % Used (N = 47) Policy Suitability Suitability Unsuitability 2 (4%) 1 (2%) 16, 43 21 Other Efectively functioning profesional 1 (2%) 9 Fitnes 7 (15%) 11, 15, 23, 24, 28, 32, 37 Inadequate Inappropriate Negative behaviors Performance concerns Personal limitations Problematic Psychologicaly wel adjusted 1 (2%) 1 (2%) 1 (2%) 1 (2%) 3 (7%) 2 (4%) 1 (2%) 14 12 49 6 18, 22, 46 30, 35 38 The most frequently cited term across policies refered to competence (19%). Across these policies, competence is often related to behaviors or performance of counseling skils or perceived profesional demeanor. An example of this is found in Q1P45: If such eforts at problem resolution are unsuccesful, or if the complaint is judged to be sufficiently serious (e.g., involving threats to client welfare or questions about the student?s ability to function competently within the training context), the program director wil inform student and his or her advisor (in writing) that a formal meting of the program faculty wil be convened to review the circumstances and to arive at a decision regarding the student?s continuation in, or termination from, the program. 55 Policies also used this term in discussions about the identification of concerns, relating to competency as found in Q1P1: It is the objective of the Counseling faculty to identify concerns about student competency as early as possible and to initiate the necesary procedures for addresing the concerns. Across these terms, the focus is often on the presence of profesional competence, sometimes clarified in the context of problems as cited in Q1P26: ? Because of this commitment, the CHDS Program strives not to advance, recommend, or graduate students or trainees with demonstrable problems (e.g., cognitive, emotional, interpersonal, technical, and ethical) that may interfere with profesional competence to other programs, the profesion, employers, or the public at large. The term deficits, and paralel terms (e.g., deficiency) was also frequently used in labeling problematic behavior (12%). This term was often used to discuss or identify a lack of skil or ability, or the need to improve upon a lack of ability in developing their skils (i.e., performance): ?Students who are identified as having deficiencies are provided asistance in order to improve their performance? (Q1P29). However, frequently the term is used without clarification of what the problematic behavior is but more focused on a global concern as referenced in Q1P42: In cases where student performance is deficient, the student should be informed (by the persons stipulated above) about the nature of the deficiency, should be encouraged to state his or her views of the situation, and, except in extreme or dangerous circumstances, given an opportunity to improve. and in Q1P48: 56 In addition, any faculty member may request such a meting at any time to expres concern about a student?s strengths and/or deficiencies. The term fitnes was also used to define problematic behavior. This term was often used to clarify appropriatenes or disposition for the profesion. An example of this use was Q1P11, which stated: ? suitability for being a profesional counselor. Fitnes implies psychological health, including the folowing variables: self-awarenes, self-aceptance, self-knowledge, self- confidence, courage, resilience, purpose in life, balance, moderation, and emotional stability. This appropriatenes for the profesion is further demonstrated in Q1P15, which states: The determination of fitnes to qualify for the degre rests solely upon the estimate that the faculty makes of the student?s right to the degre. Determinations of fitnes were expounded upon as referenced in Q1P23 which states: Indicators of emotional health and fitnes would include the following: Capacity for sound clinical and interpersonal judgment and the ability to deal with critique and conflict in a healthy and productive manner? The terms fitnes and suitability were often interchangeable as typified in Q1P19, ? evaluate students? suitability and appropriatenes for the counseling profesion. and in Q1P21, ? students may be terminated students for academic failure, ethical violations and/or personal unsuitability for the counseling profesion. 57 The other term that was reported was impairment (11%) within the textual data of the policies. This is ilustrated in the example from one policy (Q1P26) which combined the definitions of problem with impairment: For purposes of this document, a problem refers to a trainee?s behavior, which, while of concern and requiring redemption, is perceived not to be unexpected nor excesive for profesionals in training. This policy further clarified that the concern was not with problem behavior but when this behavior becomes impairment, specificaly when certain characteristics are exhibited. (Q1P26) defined impairment as, ? an interference in profesional functioning which is reflected in one or more of the following ways: An inability and/or unwilingnes to acquire and integrate profesional standards into one?s repertoire of profesional behavior, to acquire profesional skils in order to reach an aceptance level of competency, and/or to control personal stres, and/or cognitive, behavioral, and/or emotional reactions which interfere with profesional functioning. For example, policies went on to further clarify how impairment is evidenced as typified in policies Q1P4, Q1P14, and Q1P32: Examples of behaviors that may be evidence of profesional impairment include the following: violation of profesional standards of ethical codes; inability or unwilingnes to acquire or manifest profesional skils at an aceptable level of competency; behaviors that can reasonably be predictive of poor future profesional functioning, such as extensive latenes in client record-keeping or poor compliance with supervisory requirements; interpersonal behaviors and interpersonal functioning that impair one's 58 profesional functioning; inability to exercise sound clinical judgment, poor interpersonal skils, and pervasive interpersonal problems. Other examples of the use of this term include a list of possible actions to take when impairment manifest. Common Themes in How Problematic Behavior is Asesed Research Question 2 focused on how problematic behavior was asesed in each program. This includes consideration of the methods used to ases problematic behaviors, the proces of evaluating students, who is involved in evaluation and what areas may be asesed. When considering the specific methods used to evaluate and ases problematic behavior or as described by other programs competency, fitnes, or deficits, several programs use specific tools. How problematic behavior is assesed. Seventen (36%) of the policies in this sample reference a specific tool or asesment instrument to ases problematic behavior. These tools are listed in Table 3 and contained within Appendix B. Thre programs (Q2P4, Q2P52, Q2P55) were utilizing the same tool, the Profesional Characteristics Review Form (PCRF). It should be noted that one program (Q2P55) was using the PCRF but under a diferent title, the Profesional Development Review Form. The PCRF aseses problematic behavior based on the following domains: profesional responsibility, competence, comportment/maturity, and integrity. One of the evaluation criteria for measuring profesional responsibility states: ?the student relates to peers, profesors, and others in an appropriate profesional manner? (Q2P4). One of the evaluation criteria for measuring competence states: ?the student provides only those services and applies only those techniques for which she/he is qualified by education, training, and experience? (Q2P4). The evaluative criteria for comportment evaluates the student?s ?ability to receive, integrate, and utilize fedback from peers, teachers, and supervisors? (Q2P4). In 59 addition to the integrity domain addresing adherence to ?acepted code(s) of ethics/standards of practice,? it also evaluates if ?the student respects cultural, individual, and role diferences, including those due to age, gender, race, ethnicity, national origin, religion, sexual orientation, physical ability/disability, language, and socioeconomic status? (Q2P4). The domains within the PCRF also comprise the basis of tools used by other programs (Q2P11, Q2P24). For example, the tool used by Q2P11 contained the same domains of the PCRF, but had an additional domain: academic performance. One example of how academic performance is evaluated in Q2P11: ?the student is making timely progres towards completion of degre program.? The tool used by Q2P24 includes an interpersonal fitnes domain that requires students to ?exhibit interpersonal fitnes necesary to provide efective counseling interventions with clients or work with other students.? A number of other domains were represented in the tools used by other programs (Q2P9, Q2P31, Q2P39, Q2P54). The tool used by Q2P9 contained thre domains: profesionalism; planning, preparation, and productivity; and commitment to developing profesional competencies. Each of these domains contained subdomains. For example, the subdomains of profesionalism are: profesional demeanor, relationships with others, general work atitude and enthusiasm, commitment to profesional development, integrity, and profesional judgment (Q2P9). One evaluative criteria of the subdomain of profesional demeanor is: ?maintains personal hygiene? (Q2P9). The tool used by Q2P31 referenced four domains: academic skils, clinical skils, ethical and profesional behavior, and personal characteristics. Within each of these domains are one to five word descriptors such as those noted for clinical skils: ?basic atending skils, intentionality, case conceptualization? (Q2P31). The tool used by Q2P39 contains ten evaluative domains: opennes to new ideas, flexibility, cooperativenes with others, 60 wilingnes to acept and use fedback, awarenes of own impact on others, ability to deal with conflict, ability to acept personal responsibility, ability to expres felings efectively and appropriately, ability to expres felings efectively and appropriately, atention to ethical and legal considerations, and initiative and motivation. The tool used by Q2P54 evaluates problematic behavior based on profesionalism, general competency, social and emotional maturity, integrity and ethical conduct, and clinical competency. Clinical competency must be evidenced by ?the student demonstrates the core conditions of counseling: unconditional positive regard, genuinenes, and empathy? (Q2P54). Table 3 Tools Used to Ases Problematic Behavior Tool Policy Candidate Evaluation of Dispositions Counseling Student Competency Evaluation Doctoral Screning Form Doctoral Student Disposition Form Faculty Review of Student Performance Form Form for Screning Students Personal Characteristics Checklist Personal Characteristics Review Form Profesional Characteristics Review Form Profesional Characteristics Review Form P9 P54 P41 P15 P31 P21 P1 P32 P52 P4 (table continues) 61 Table 3 (continued) Tool Policy Profesional Conduct Concerns Form Profesional Development Form Profesional Development Review Form Profesional Fitnes Evaluation Form Profesional Performance Fitnes Evaluation Form Profesional Performance Standards Evaluation Student Progres Evaluation Form Student?s Profesional Competency Progres Report P10 P6 P55 P11 P24 P39 P30 P30 In addition to the academic requirements of doctoral candidates are the non-academic requirements that comprise each of the referenced tools in Table 3. The tools used by several programs (Q2P1, Q2P6, Q2P10, Q2P15, Q2P32, Q2P41) do not contain domains but evaluate problematic behavior based on uncategorized descriptors. For example, one of the descriptors states: ?the student appears to be a candidate who is able to project a future-mindednes? (Q2P1). Yet another descriptor found in Q2P41 is: ?reliability.? A descriptor found in Q2P10 looks at: ?exercising good judgment in sharing personal felings, thoughts and experiences.? Within this same tool (Q2P10) faculty must ?describe problematic behavior including context? once a concern has been noted. One tool (Q2P15) evaluates students based on their ?ability to cary out safety measures and to handle emergency situations.? This crisis intervention descriptor was unique in that no other tools asesed problematic behavior in this way. 62 Conversely, the tool used by Q2P21is devoid of domains and descriptors and utilizes an open-ended approach to ases problematic behavior. Faculty are prompted to describe concerns using an open-ended approach in Q2P21 as noted: ?behavioral description of faculty concerns.? This particular tool is two-fold in that faculty are also to indicate ?expected changes in behavior? (Q2P21). Across tools, common themes emerged: profesional responsibility, profesional competence, profesional maturity, and profesional integrity. These themes are ilustrated in Table 4 along with codes describing the competencies. Table 4 Common Asesment Areas Used in Tools to Ases Problematic Behavior Category Code Profesional responsibility Relates to others in an apropriate profesional maner Does not exploit or mislead other people Aplies legal and ethical standards Takes responsibility for compensating for deficiencies Engages in profesional growth and comited to profesional development Exercises sound judgment Sensitivity to real and ascribed diferences in power Punctuality, profesional apearance, atendance and dependability Profesional competence Recognizes boundaries of competence and limitations of expertise Basic cognitive skils and apropriate afect in response to clients (table continues) 63 Table 4 (continued) Category Code Profesional maturity Self-control (anger & impulse control) in interpersonal relationships Ability to cary out safe measures and handle crisis Honesty and fairnes Aware of own belief system, values, and limitations Receive, integrate, and utilize fedback from others Profesional integrity Does not make false, misleading or deceptive statements Wilingnes to use self-reflection to promote profesional growth Respects the rights, dignity and worth of al people Respects individual diferences and culture Adherence to ethical codes and standards of practice Subsequently, a smal number (6%) of policies (P23, P49, P51) contained non-academic or skil performance expectations within the policy on problematic behavior. This includes emotional behaviors or health, interpersonal dynamics or other non-cognitive focused areas. One policy (Q2P23) that demonstrates the usage of these characteristics follows: Students must consistently and reliably display a level of emotional strength and balance that alows them to efectively cary out the duties of a competent counselor or counselor educator. Indicators of emotional health and fitnes would include the following: Capacity for sound clinical and interpersonal judgment and the ability to deal with critique and conflict in a healthy and productive manner; reliable completion, even under conditions of stres and emotional chalenge, of expected clinical and academic responsibilities; and a respect for diversity of beliefs, practices, appearances, and 64 orientations, and a commitment to, and capacity for self-reflection regarding isues related to diversity.? One policy (Q2P49) charges faculty to look at ?academic and non-academic behaviors that have raised concern? and provides a list of characteristics expected of a succesful student which include: ?integrity and self-awarenes.? Policy Q2P51 ?requires faculty to consider both cognitive and noncognitive performance? every semester based on a scale from 1 to 5, ranging from no concerns (1) to program suspension or termination (5). Although a scale is used to ases the student, there is no formal tool provided. When problematic behavior is assesed. The frequency of asesments as indicated in the policies ranged from no mention of frequency (28%), ongoing/every semester (47%), quarterly (2%), biannualy (4%), and annualy (19%). These frequencies are ilustrated in Table 5. Distinctions were made betwen informal and formal asesments as demonstrated in Q3P23, ?continuously monitor students? dispositions, behaviors and general progres through the program?informaly throughout the year and formaly once a year for al students.? 65 Table 5 Frequency Problematic Behavior is Asesed No Mention Ongoing/Every Semester Quarterly Biannualy Annualy P2 P12 P13 P19 P22 P36 P40 P43 P44 P45 P46 P47 P54 P1 P4 P9 P14 P15 P16 P17 P26 P27 P29 P31 P32 P33 P34 P37 P39 P42 P48 P50 P7 P21 P35 P6 P10 P11 P23 P24 P28 P30 P41 P49 (table continues) 66 Table 5 (continued) No Mention Ongoing/Every Semester Quarterly Biannualy Annualy P51 P52 P55 Who asseses problematic behavior. In consideration of who was asesing problematic behavior within each program the themes reflected program faculty and/or a faculty member (66%), entire program faculty (11%), a commite of faculty members (4%), supervisors (undefined) (2%), and a number of programs (17%) did not specify who asesed problematic behavior. An example of the use of the entire program faculty is represented in Q3P31, ?student reviews are conducted with the participation of al program faculty.? The commite of faculty members is demonstrated in Q3P49 as ?at the beginning of each fal semester, Program Coordinators for each Master?s/Ed.S./Doctoral program wil name a Review Commite of two faculty members who wil have the responsibility of reviewing the non- academic reports for Master?s/Ed.S./Doctoral students in their respective program.? Lastly, the use of supervisors for asesing problematic behavior is typified in Q3P14, ?supervisors, through ongoing supervise asesment and evaluation, should be aware of any personal or profesional limitations of supervises which are likely to impede future profesional performance.? Once the problematic behavior has been identified policies denote a progresive tiered system of involvement to include the faculty advisor, program chair, commite, department head and a university conduct board. 67 The majority of the policies (62%) did not reference a tool to ases problematic behavior, focused more on asesment as being part of continual and/or annual evaluation of students. This is demonstrated in the following policy: At any point in the program, if a faculty member has serious concerns about any of the following: a student?s behavior, a student?s competency as a counselor in training, or the personal or profesional characteristics of a student that are not appropriate for a counselor in training, the faculty member shal, after confidential consultation with one or more full-time faculty members in the program, initiate the proces outlined below. (Q2P27) Additional examples of these common themes of annual or continual evaluation include: ?faculty members met regularly in order to evaluate each student's progres in academic work, teaching, supervision, counseling skils, and intrapersonal/interpersonal efectivenes? (Q2P29) and policy Q2P33 communicates ?the progres of al students wil be reviewed each semester by faculty members when there is concern about a particular student.? Common Themes in the Proces and Procedures Identified for Remediation of Problematic Behavior Research Question 3 examined the proces of remediation once problematic behavior has been identified within the program. The majority (72%) of remediation proceses followed a steps or stages proces although they were presented in varying formats (bulleted, narative, and numbered). Common across programs that used steps or stages the initial part of the proces involved notification (74%) and the student?s rights related to responding to the notification. Policies that clarified the stage of student notification are ilustrated by Q3P15, ?The doctoral program coordinator and the student?s advisor send the student a certified leter with a return 68 receipt that contains writen notification that a problem exists.? Notification was either communicated first in writing or through a face-to-face meting as sen in Q3P1 which indicates that faculty ??wil confer with the student, and wil provide the student and the program coordinator with a copy of the form (Personal Characteristics Checklist).? A similar approach is taken by Q3P5: ?The faculty member and student wil discuss the problems, review appropriate measures of correction, and establish a timeline for change,? and by Q3P3 as ilustrated in this statement, ?At the first level of action, an individual faculty member wil met with the student in question, expres the specific concern(s), and sek to establish a plan to resolve the situation before further action would be necesary.? Policy Q3P6 indicates ?Each student wil receive a leter from the program chair that summarizes the results of the review proces.? After notification, many policies included options focused on aserting the student?s rights to disagre or directly respond to the asertion that a problematic behavior was present or demonstrated. Policies that addres student?s rights to disagre with the asesment of problematic behavior(s) are ilustrated with this policy (Q3P6): ?The student may appeal this decision first to the faculty Advisor, then through the Program Director, and if necesary to the Dean. If a satisfactory solution is not reached, the student can then follow established university due proces guidelines.? This appeal often can only come after the student has met with faculty as indicated in the previous response and in Q3P11: ?The student must appeal, in writing, to the Department of Counseling Chairperson for resolution of the isue. Only after confering with the Department of Counseling Chairperson may the student appeal to the College of Education Dean.? Policy Q3P4 indicates that: ?The student wil be given an opportunity to met with the commite to present his/her own version of the facts. The meting shal be open only to members of the Faculty Retention Commite, the student, and those individuals considered to 69 have relevant information and are approved by the commite chair to speak to the commite.? Yet another example regarding appeal is sen in Q3P10, ?Following discussion of a student?s conduct during either the annual evaluation period, or as a result of continuous monitoring, the student wil be provided an opportunity to present their perspective regarding the mater.? In programs using a stage or step proces the most common (79%) next step after notification involved the development of a remediation plan. Some policies (21%) indicated that the plan was developed and sent to the student without collaboration, ?If any remediation is indicated, the leter wil explain what is expected of the student based on a remediation plan? (Q3P6). A similar approach was also found in Q3P15, ?This leter wil include a request for a response that contains a remediation plan and an implementation timeline to addres the identified problem area or areas.? These proceses may paralel those focused on asesing the student?s right to respond. A larger percentage (51%) of programs reporting the development of remediation plans discussed a more collaborative approach. A more collaborative approach to the development of the remediation plan was found in one policy (Q3P1), after confering with the student, if the student is in agrement with the instructors finding then two options are noted: ?? (a) specified remedial procedures or (b) exit from the program..? With the development of a remediation plan are time parameters as indicated in one policy (Q3P32), ?The faculty member and student wil discuss the problems, review appropriate measures of correction, and establish a timeline for change.? These policies reinforce collaboration and communicating to the student al aspects of remediation proces including consequences of being unsuccesful in achievement of plan goals as found in one policy (Q3P52): ?? faculty member wil discuss with the student ? and consequences if remediation is unsuccesful.? Provisions were also noted when initial remediation atempts were unsuccesful as indicated in one policy (Q3P23), 70 If the student?s patern of misconduct or inappropriate disposition persists in spite of remediation eforts, the following wil take place: a. The student wil receive a leter from the department chair informing them that their continuation in the program is in jeopardy. b. Full-time program faculty and other faculty relevant to the case wil met to decide whether: i) further remediation should be considered, in which case the student wil receive a writen detailing of the remediation steps, i) the student wil be told to take a mandatory leave of absence, or ii) the student wil be dismised from the program. In programs using stages and steps the majority (70%) of programs had policies that addresed what would happen if remediation was unwaranted and/or was unsuccesful. Step thre addresed this proces. One example of a response that supported this stage was one that stated that when the remediation proces was unsuccesful and dismisal is likely, ?counseling faculty have the responsibility to dismis students?,? however; within this policy (Q3P4) those proceses for completing this step was not provided. Other programs ilustrated the dismisal outcomes but clarified (Q3P21): ?If the decision is to terminate, the student?s afiliation with the program, the student wil be notified in writing. The nature of the problem and the basis for the final decision wil be clearly stated.? Upon notification of a dismisal decision time parameters were provided, ?The student wil be given 14 days to prepare a response to the notification of dismisal and have the opportunity to request a formal review of the recommendation for dismisal from the School Director in which the program is housed? (Q3P26). When counseling out of the program and/or dismisal was necesary, one policy (Q3P16) communicated faculty 71 responsibility, ?In these cases, students shal be asisted in identifying an area of study or specialization that is more suited or appropriate to their talents and skils.? Remediation procedures were not always found within the policies, in the current review a number of programs (19%) did not report or outline any specific procedures for remediation. Although the remediation procedures were not within Q3P9, the policy did indicate they were in another document, ?Students not displaying an appropriate level of profesional behavior at any of these evaluation points wil be provided with opportunities for remediation as outlined in the CSP Graduate Student Manual.? The referenced manual was not electronicaly acesible; therefore, the remediation procedures could not be reviewed. Two programs (Q3P16, Q3P36) only referenced remediation for failure of comprehensive examinations, ?Students who do not pas al six questions after the second atempt must met with their program commite and develop a remediation plan? (Q3P16); likewise Q3P36 indicates ?The faculty wil render a final decision regarding the completion of the comprehensive exam. The faculty wil also be available to met with the candidate to discuss findings and provide suggestions for remediation.? Sumary This section analyzed the results of the content analysis on forty-seven (N = 47) CACREP-acredited doctoral counselor education program policies addresing problematic behavior in counselors-in-training. Demographic information about each program that is represented in the sample was noted. The results of the content analysis provided information specificaly looking at the terms used to describe problematic behavior, how problematic behavior is asesed, and how it is remediated. The implications of the survey are discussed in the next chapter. 72 CHAPTER V. DISCUSION Introduction The criticality of the evaluation of counselors-in-training is evident throughout acreditation standards and ethical codes. As outlined in the ACA Code of Ethics (2005), counselor educators and supervisors are imparted with the responsibility of ?providing supervises with ongoing performance appraisal and evaluation fedback? (F.5.a.). Further, CACREP standards indicate that programs and faculty engage in the use policies and procedures that outline how students wil be evaluated for personal fitnes to continue in a counseling program (CACREP, 2009). However, there exists a paucity of profesional literature to addres this proces and its implementation in counselor education programs. This includes limited research that provides information or resources to counselor educators on how this is done while integrating CACREP standards. In response to the absence of research in this area, this study explored how CACREP doctoral programs addres this task. This included how programs defined problematic behavior, including the specific terms used by the programs to label this behavior. Further, this study examined how problematic behavior was asesed within programs and the specific methods or proceses involved in remediation. This was done by examining qualitative data from electronicaly asesable program handbooks. This chapter provides a discussion of these findings, limitations of the study, potential implications, and future recommendations for future research. 73 Discusion of the Findings The findings of this study provide an exploratory and descriptive outline of the retention and remediation policies in CACREP acredited counselor education doctoral programs. The present content analysis includes programs with acreditation timelines ranging from one (1) to thirty-one (31) years. CACREP Standard I.L.2.d. requires that programs provide readily acesible retention and remediation policies for students and potential candidates for admision (CACREP, 2009). These policies should include information about the areas evaluated in a program, how those are defined and asesed, and the specific policies and procedures that are used in remediation. The results in the current study are promising. The majority of programs have readily acesible policies in the public domain; specificaly, 44 programs out of 58 had acesible policies. This acesibility is a critical aspect of informed consent, alowing potential candidates for a program to consider these aspects before making a decision about entering a program. Prior to entering a program, potential candidates can review how the program defines problematic behavior. Research Question 1 A preliminary area of exploration in the current study was identifying the way that problematic behavior is in esence labeled in programs. Despite a body of research (Brear et al., 2008; Oliver, et al., 2004; Rosenberg et al., 2005; Vacha-Hase et al., 2004, Wilkerson, 2006) that purports the need to use a common language, a plethora of terminology is used in counselor education doctoral programs to describe problematic behavior. Terms such as deficient, problem, profesional performance deficiencies, incompetent, bad, problematic students/trainees, profesionaly deficient trainees, troublesome, unsuitable, and impairment have been cited in the literature (Boxley, Drew & Rangel, 1986; Brear et al., 2008; Cobb 1994 as cited in Wilkerson, 74 2006; Forrest et al., 1999; Gaubatz & Vera, 2002, 2006; Huprich & Rudd, 2004; Lamb et al., 1987; McAdams & Foster, 2007; Olkin & Gaughen, 1991; Procidano et al., 1995; Rosenberg et al., 2005; Russel & Peterson, 2003; Wheeler, 2000). Many of these terms are mared with criticism and alternative terms dealing with character, fitnes, and problematic behavior have been suggested to replace these terms. Recent studies (Brear et al., 2008; Oliver, et al., 2004; Rosenberg et al., 2005; Vacha-Hase et al., 2004) suggest adoption of the term problematic, which Wilkerson (2006) and Kres and Protivnak (2009) define and describe. Across programs, multiple terms: competence, deficits, impairment, suitability, fitnes, and negative behaviors were used to label this type of behavior. These terms were often not only consistent across programs but it was chalenging to determine the definition or parameters of the terms. Program handbooks in most instances did not define the term or terms used in their retention or remediation policies, which may make it dificult for a student to understand the exact meaning or nature of the behavior being labeled. Some of the terms used cary a negative connotation; terms such as competence, deficit, or impairment. When commonalities were considered the data suggested that the focus across the majority of policies was often on the presence of profesional competence. This competence was related to behaviors, demonstration of counseling skils, and/or profesional demeanor. The term deficit was also cited in a number of policies, typicaly labeling problematic behavior. Despite a body of research (Frame & Stevens-Smith, 1995; Vacha-Hase, Davenport & Kerewsky, 2004) that has indicated the term impairment should be distinguished from problematic behavior because of implications asociated with the ADA, the term continues to be used. The variance in terminology used suggests that a consensus has yet to be reached and therefore terminology varies from university to university. Policies do not reflect adoption of the 75 term problematic behavior despite recommendations that have been made to shift from terms with negative connotations to a term that is more reflective of what is being asesed. The transition to a single term ay only be possible when acrediting bodies and profesional standards adopt and explicitly define the term. Furthermore, use of the term alone may not be sufficient to encapsulate how problematic behavior is asesed. Programs might find it beneficial to define not only this term but other terminology used to describe problematic behavior. This proces of defining provides an important foundation to the proces of asesing problematic behavior. Research Question 2 Few programs used formal tools to ases problematic behavior. Among programs that reported not using an asesment tool, problematic behavior was addresed at varying points within a program through identification by a faculty member(s). This means of asesing student behavior contributes to what has already been identified as chalenging and principaly subjective (Brear et al, 2008). Such an approach may lend itself to legal chalenges. Not al programs, however, take this approach and reference specific tools to ases problematic behavior. These tools provide evaluative criteria to measure problematic behavior on constructs such as profesional responsibility, profesional competence, profesional maturity, and profesional integrity. It was evident that ethical codes influenced the evaluative criteria for profesional competence in the PFEF, ?The student provides only those services and applies only those techniques for which she/he is qualified by education, training, and experience? (Q2P11). This evaluative criteria is reflective of language from the ACA Code of Ethics (2005), ?Counselors practice only within the boundaries of their competence, based on their education, training, supervised experienced, state and national profesional credentials, and apropriate 76 profesional experience? (Section C.2.a.). Despite the influences of ethical codes and standards, minimal consensus is found across programs in the evaluative criteria referenced in the tools. Identification of problematic behavior through use of formal tools alow for transference of content to the remediation plan. The results of this study confirm that most programs do not reference nor make publicaly acesible a formal tool for asesing problematic behavior. Thus, it does not appear that systematic and comprehensive evaluation criteria has been adopted among the programs. In addition to the tools and evaluative criteria contained within the policies, the proceses employed to ases problematic behavior were analyzed. It was interesting to note that while the asesment of problematic behavior is predominantly ongoing, some programs make no reference to the frequency of asesing problematic behavior. This general approach to discussing evaluation mirors ethical standards that indicate appraisal is ongoing and periodic (Section F.5.a.). Yet another reason why no reference to frequency is made may be linked to the asumption that problematic behavior is being informaly asesed throughout a program. However, does this lack of clearly identified periods of evaluation met muster of ethical codes which indicate that counselors clearly state the timing of evaluations (Section F.9.a.)? Forrest et al. (1999) highlight that programs not completing annual evaluation are vulnerable in many ways for incompliance with ethical codes, acreditation standards, and potential legal chalenges. When a frequency of asesment was identified, programs either asesed problematic behavior annualy or every semester. These noted frequencies are aligned with periods where problematic behavior is formaly asesed. Yet another proces that was analyzed was who was asesing problematic behavior. This qualitative review also found that problematic behavior is overwhelmingly asesed by program faculty and/or a faculty member. In some instances, it was noted that the entire 77 program faculty is used to ases problematic behavior. Programs may choose this approach to preclude students from feling singled out by a particular faculty member. This approach may provide a more comprehensive asesment and reduce legal liabilities. It is also noted that a smal number of programs do not publicaly identify who is responsible for asesing problematic behavior. And an even smaler number utilize a named commite of faculty members to ases problematic behavior. Once faculty members have evaluated students and problematic behavior is evident and remediation is necesary, it was important to note the proceses and procedures employed by the programs. Research Question 3 Information available within the policies to addres the proces and procedures for remediation of problematic behavior ran the gamut, from very detailed and lengthy proceses to proceses that were limited in detail. The proceses semed to take a natural ordering, beginning with notification of concerns. The notification however, varied betwen a number of programs notifying the counselor-in-training through certified leter and other programs notifying through a formal face-to-face meting with faculty. While there certainly are pro?s and con?s around why a program notifies in the manner in which they do, it would sem that because of the nature of the information a counselor-in-training would at a minimum have a face-to-face meting to discuss these concerns. Litle has changed since Olkin and Gaughen (1991) found that student evaluations were routinely (57%) communicated in writing and only 43% were presented oraly. However, Dufrene and Henderson (2009) provide a framework for remediation and note ?A meting is aranged with the faculty clinical coordinator, supervisors, and the trainee,? to discuss remediation and a remediation plan. Kerl et al. (2002) notes a similar approach with a legaly 78 supported evaluative proces, ?A student who does not met minimum criteria on the PCPE is informed during an individual meting?.? Of greater concern, is the fact that a number of the programs have developed the remediation plan prior to any response and/or input from the counselor-in-training concerning the problematic behavior and the methods selected to remediate the concern(s). This approach may be taken due to the lack of guidance available in the literature and within standards around procedures for implementing remediation (Dufrene & Henderson, 2009). This type of proces may also bear concerns around a framework that would support due proces. It was noted that remediation of problematic behavior is time limited; however, the actual time limits were not provided by many programs. This may be due to the variance from student to student on achieving the goals of the remediation plan. The options available to remediate problematic behavior were consistent with those previously reported in the literature and noted in chapter two. Only five policies included these options used for remediation of problematic behavior. In al of these policies, recommending and/or requiring personal counseling was a common strategy used among programs. Other common possible options were increased supervision, leave of absence, reduced practicum or internship, formal reprimand, formal probation, counseling out of the program, and dismisal from the program. These options are commonly cited in the literature (Forest et al, 1999; Olkin & Gaughen, 1991; Vacha-Hase, Davenport, & Kerewsky, 2004; Ziomek-Daigle & Christensen, 2010). Of the policies that provided information on remediation, typicaly the rights of the students were noted following these proceses. A separate source was cited to aces most appeal procedures. The policies clearly articulate that students? right to appeal are critical when a student is in disagrement about the problematic behavior. It is esential that policies continue 79 to provide this information and it may be of benefit for those procedures to be listed along with the information on problematic behavior. The results of this study identified that multiple terminology is being used to describe problematic behavior and programs have yet to shift to single term. This study revealed that few programs used a formal tool to ases problematic behavior and systematic and comprehensive evaluation criteria are yet to be adopted among programs. Additionaly, this study found the proceses and procedures for remediation of problematic behavior began with notification and culminated in student rights. In sum, the results of this study identified some limitations in how programs define, ases and remediate of problematic behavior. Limitations The findings of this study need to be considered in light of specific limitations. Information collected for this study was limited to data that could be obtained via electronicaly acesible content. The nature of this data collection has limitations that impact the generalizabilty of the findings. For example, 11 websites did not provide policies and procedures for analysis. An email request to these program requesting policies and procedures may have increased the number of policies reviewed. Additionaly, the policies and procedures that were acesible may not be reflective of the most current policies and procedures. It is also possible that additional policies and procedures exist that are not reflected in the electronicaly acesible documents. An email request to each program requesting the curent policies may have ensured the most current and complete policies were reviewed. The content categories were developed by a single researcher with mutual agrement from an external researcher to ensure validity. It is possible that other reviewers may have constructed content categories in a diferent manner. Content analysis always has the limitation 80 that there may be subjective diferences in the analysis and coding of data. While an external reviewer was used to minimize this efect, it is critical to acknowledge this limitation in analysis (Creswel & Miler, 2000). Individual variance may lead to diferences in coding or the conclusions that are drawn. In addition, the content captured for this study represented doctoral programs only. There are far more CACREP-acredited masters level programs; it may have been advantageous to analyze content from these programs as wel. Therefore the results of this study may not be generalizable to master?s only and non-acredited counselor education programs. This study was exploratory in nature; however, despite the noted limitations, the data might benefit counselor educators and researchers refining retention policies addresing problematic behavior. Recommendations for Future Research This study was exploratory in nature, providing a preliminary look at the policies and procedures addresing problematic behavior in doctoral CACREP-acredited programs. It is clear that there is a need for additional research into this topic. This study looked only at doctoral policies that were acesible in the public domain. Delving deeper and requesting hard copies of policies from each program ight be of benefit to determine if what is provided by the university is also what is publicly acesible. Qualitative studies could expand on findings from this study and review master?s level programs, comparing diferences that may exist betwen master?s and doctoral programs. Yet another area for research consideration is replication of this study comparing CACREP- and non-CACREP-acredited programs. Such a study might reveal if diference exist in how problematic behavior is define, asesed, and remediated. 81 Implications This study identified some limitations in how problematic behavior is defined and described, and in the proces of asesment and remediation of problematic behavior. Counseling literature is replete with discussions on the plethora of terminology that has been used to describe problematic behavior. Although the profesion has been caled upon to adopt a single term that appropriately describes problematic behavior, this needs more atention. Given the variation among terminology used among programs, it is recommended that acreditation standards and ethical codes define problematic behavior and utilize a specific term. An implication resulting from this study is the need to shift from terminology that has negative connotations and legal implications to describe problematic behavior. Therefore it is recommended that programs define problematic behavior and adopt the term problematic behavior for consistent use throughout retention policies and procedures. Having a generaly agred upon term wil benefit counselors-in-training as they make decisions about entering a program, self-monitoring, and peer identification. Adopting a single term, clearly defining that term, and using that term consistently within policies and procedures wil aid the asesment of problematic behavior. Given the variation across programs on the means to ases problematic behavior, it is recommended that current asesment proceses be analyzed and reviewed. There is a lack of congruence across programs on how problematic behavior is asesed. Programs need to outline specific criteria to ases problematic behavior because of the elusivenes and vaguenes represented in a number of the reviewed policies. It is recommended that programs move away from strictly subjective means to ases problematic behavior and consideration be given to the 82 use of a formal tool to ases problematic behavior. It is further recommended that the frequency of asesment be clearly identified in policies. Despite the number of students who aces information electronicaly and CACREP (2009) requires that student handbooks be diseminated to students (Section L.2.), a number of handbooks were not readily acesible. Another concern raised in this study is the proceses and procedures for remediating problematic behavior once identified. Remediation proceses and procedures were often unclear, although CACREP (2009) standards indicate that handbooks are to include retention policies that explain the procedures for remediation (Section L.2.d.). It is the recommendation of this researcher, that policies acurately describe the remediation proceses and procedures and be electronicaly acesible. This study underscores the recommendation of Forrest et al. (1999) that a model program policy about evaluation and remediation be developed that is inclusive of expanded options for remediation. Retention policies are a necesary aspect of the profesion and as such this study strongly encourages a review of existing retention policies using the information and conclusions provided in this study. Sumary This study found that doctoral Counselor Education programs have failed to shift to a single term to define and describe problematic behavior, programs continue to rely on principaly subjective means to ases problematic behavior, and proceses and procedures to remediate problematic behavior are varied across programs. Problematic behavior wil ultimately be encountered within counselor education programs; however, wel-designed policies are said to improve the ability to prevent, identify, and efectively remediate them (Gaubatz & Vera, 2006). 83 These policies and procedures wil aid Counselor Educators, who have a profesional responsibility to be efective gatekeepers. 84 REFERENCES American Counseling Asociation. (2005). ACA code of ethics. Alexandria, VA: Author. American Counseling Asociation. (2009). ACA?s Taskforce on Counselor Welnes and Impairment. Retrieved from http:/ww.counseling.org/welnes_taskforce/index.htm American Psychological Asociation. (2002). Ethical principles of psychologists and code of conduct. Retrieved from http:/ww.apa.org/ethics/code/index.aspx American Psychological Asociation. (2007). Guidelines and principles for accreditation of programs in profesional psychology. Washington, DC: Author. Arter, J., & Spandel, V. (1992). 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Journal of Counseling & Development, 88(4), 407?415. 94 Appendix A List of Policies Reviewed Duquesne University Florida Atlantic University Georgia State University Idaho State University Kansas State University Kent State Minnesota State University isisippi State University North Dakota State University North Carolina State Oakland University Ohio University Old Dominion University Oregon State University Regent University Sam Houston State University St. Mary's University Syracuse University Texas A&M Commerce Texas A& Corpus Christi Texas Tech University University of Akron University of Alabama University of Arkansas University of Central Florida University of Cincinnati University of Florida University of Iowa University of Maryland University of isisippi University of Misouri University of Nevada Reno University of New Mexico University of North Carolina University of North Texas University of Northern Colorado University of Rochester 95 University of South Carolina University of Tennese University of Texas San Antonio University of Toledo University of Virginia University of Wyoming Virginia Tech Wayne State University estern Michigan University Wiliam & ary 96 Appendix B Tools Used To Ases Problematic Behavior Policy 9 97 98 99 100 101 Policy 54 Counseling Student Competency Evaluation 102 103 104 Policy 41 105 Policy 15 106 107 Policy 31 108 109 Policy 21 Form for Screning Students Student: Commite: (Advisor) (Faculty member) (Faculty member) Behavioral description of faculty concerns: Expected changes in behavior: Time frame: Failure to remediate may result in termination from the program. Signatures: Student Date Advisor Date Faculty member Date Faculty member Date 110 Policy 1 Personal Characteristics Checklist Student ID # Course Date Low Average High No Oportunity 111 Policy 32 Personal Characteristics Review Form (PCRF) * Student _______________________________________ Semester/Year _________________ Faculty _______________________________________ Evaluation Criteria N = No opportunity to observe 0 = Concerns 1 = No Concerns 2 = Student demonstrates excelence N 0 1 2 1. The student behaves in acordance with the 2005 Code of Ethics of the American Counseling Asociation. 1. The student relates to peers, profesors, and others in an appropriate profesional manner. 3. The student does not exploit or mislead other people during or after profesional relationships. 4. The student demonstrates awarenes of personal and profesional limitations as these relate to service provision 5. The student takes responsibility for compensating for her/his limitations and/or personal isues, which may negatively influence her/his work. 6. The student demonstrates appropriate self-control (such as anger control, impulse control) in interpersonal relationships with faculty, peers, clients, and staf (university and field placements). 7. The student demonstrates awarenes of her/his own belief systems, values, and needs and takes appropriate precautions to avoid imposing these on others. 8. The student demonstrates the ability to receive, integrate and utilize fedback from peers, faculty, and supervisors. 9. The student respects the rights of individual to privacy, confidentiality, and choices regarding self-determination. 10. The student demonstrates respect for cultural and individual diferences in their profesional interactions. Comments: *Adapted from work created by XXX University Counseling Program. 112 Policy 52 113 Policy 4 114 Policy 10 115 116 Policy 6 NOTE OF CONCERN AND PROFESIONAL DEVELOPMENT FORM (PDF) A Note of Concern As the administration and faculty of the School of Psychology and Counseling of XXXX University is invested in your succes in your graduate program, we would like you to make an appointment with the person noted below to discuss the specific isue outlined, so that you may move toward the succesful carer you desire. Please cal or email _____________________________________________ By _________________________ (date) to make an appointment to discus the following. This note is a means of working with you as part of your educational proces. Thank you for your cooperation. If this isue is resolved this information does not go into your file; however, your failure to make this appointment could have consequences you did not intend. 117 Summary of Meting Date: Participants: Subject of Discusion: Plan for Student: Student Signature of Agreement Folow-up meting set for (date) 118 School of Psychology and Counseling PROFESSIONAL DEVELOPMENT FORM Student: _______________ Faculty: ______________ Class/Activity:____________ Date:________________ AREA(s) FOR IMPROVEMENT General Knowledge: Development of an appropriate professional knowledge base is deficient. ______________________________________ ______________________________________ Subject Knowledge: Important knowledge of specific topics relevant to a course or required area of study is substantially below that expected. _____________________________________ _____________________________________ Professional Conduct/Workmanship: The student's conduct or productivity reflects inadequate attention to detail, diligence, punctuality, self-motivation, or preparation. _____________________________________ _____________________________________ Comunication/ Expression: Substantial weaknesses are displayed in the student's oral and/or writen expression skils such as por presentation skils, incompetence in the presented content, and por self-confidence. _____________________________________ _____________________________________ Application: Deficiencies are evident in the student's ability to apply theoretical or academic knowledge to practical situations that require analysis and synthesis. _____________________________________ _____________________________________ Self-Control/Maturity: The student displays behavior/traits that sugests an inability to regulate themselves in a professional manner, such as inflexibility, indiscretion, hostility, severe self-confidence deficits or impulsivity. ______________________________________ ______________________________________ 119 Relationships: Serious interpersonal deficits are present reflected by an inability to initiate and/or sustain appropriate relationships. _____________________________________ _____________________________________ Ethical Practice: The student has displayed unethical conduct or insensitivity to ethical isues commensurate with their professional level. _____________________________________ _____________________________________ Integration: The student approaches the integration of faith and learning in a manner that is below that expected. Two examples of this deficit are a disregard for client spirituality and a naive appropriation of Scripture in therapy that does not reflect sound clinical practice or god hermeneutics. _____________________________________ _____________________________________ PROFESSOR'S COMENTS/RECOMENDATIONS (Attach additional sheet, if necessary. Show specific actions student is to take and specify date due. Show consequences if actions not completed by due date.) _____________________________________ _____________________________________ ___________________ ______ (Faculty Signature) (Date) STUDENT ACKNOWLEDGEMENT I have been shown this completed form, and accept my responsibility for the consequences as stated if I fail to comply. (Consequences can range from los of points in a course, to failing the course, to dismisal from the program, and options in-between.) I understand that I may generate a letter of response to be included with this form, should I so chose. ____________________ _____ (Student Signature) (Date) I refuse to sign this form. _____________________________________ __________ (Student Signature) (Date) 120 Policy 55 121 122 Policy 11 PROFESIONAL FITNES EVALUATION Rating Scale N ? No opportunity to observe 0 ? Does not met standards for program level 1 ? Minimaly or inconsistently mets standards for program level 2 ? Consistently mets standards for program level Profesional Responsibility _____1. The student conducts self in an ethical manner so as to promote confidence in the counseling profesion. _____2. The student relates to profesors, colleagues, supervisors, and others in a manner consistent with stated program standards. _____3. The student demonstrates sensitivity to real and ascribed diferences in power betwen themselves and others, and does not exploit or mislead other people during or after profesional relationships. _____4. The student demonstrates application of legal requirements relevant to counseling training practices. Profesional Competence _____1. The student recognizes the boundaries of her/his particular competencies and the limitations of her/his expertise. _____2. The student takes responsibility for compensating for her/his deficiencies. Is open to supervision and fedback. _____3. The student takes responsibility for asuring client welfare when encountering the boundaries of her/his expertise. _____4. The student provides only those services and applies only those techniques for which she/he is qualified by education, training, or experience. _____5. The student demonstrates knowledge and respect for Departmental, and outside agency policies and procedures. Profesional Maturity _____1. The student demonstrates appropriate self-control (such as anger control, impulse control) in interpersonal relationships with supervisors, instructors, colleagues and clients. _____2. The student is honest, fair, and respectful of others. 123 _____3. The student is aware of his/her own belief systems, values, needs, and limitations and the efect of these on his/her work. _____4. The student demonstrates ability to receive, integrate and utilize fedback from colleagues, supervisors, and instructors. _____5. The student follows profesionaly recognized problem solving proces, seking to informaly solve problems first with the individual(s) with whom problem exists. Profesional Integrity _____1. The student refrains from aking statements which are false, misleading or deceptive. _____2. The student avoids improper and potentialy harmful dual relationships. _____3. The student respects the fundamental rights, dignity, and worth of al people. _____4. The student respects the rights of individual to privacy, confidentiality, and choices regarding self-determination and autonomy. _____5. The student respects cultural, individual, and role diferences including those due to age, gender, race, ethnicity, national origin, religion, sexual orientation, disability, language, and socioeconomic status. Academic Performance _____1. The student is making timely progres towards completion of degre program. _____2. The student maintains a cumulative grade point average of 3.00 or above. Note: Each student in the Counselor Education and Supervision Program wil be reviewed annualy using the Profesional Fitnes Evaluation. If a student receives ratings of ?0? or ?1? (mets criteria only minimaly or inconsistently for program level) he/she wil be required to met with his/her Faculty Advisor and develop a remediation plan, with remediation expected no later than the following student review. It should also be noted that some negative ratings are so detrimental to program integrity and profesional responsibility that program faculty may deem student dismisal from the program as an appropriate remedy. 124 Policy 24 125 126 127 Policy 39 128 129 130 131 Policy 30 This page intentionaly left blank because the Student?s Profesional Competency Progres Report and the Student Progres Evaluation Form where not contained within the handbook although they were referenced as tools acesing problematic behavior.